This Respectful Insolence blog post reports on yet another in an increasingly long line of medical studies that demonstrate that acupuncture is nothing more than an elaborate and fancy placebo. In this particular study involving patients in "true" acupuncture and "fake" acupuncture protocols, patients in the sham acupuncture group improved more than patients in the "true" acupuncture group.
My conclusion? On one hand, if you stick pins in people who are complaining about something, then some of them will eventually quit complaining. On the other hand, if you take pins out of some people who were previously complaining, then some of them will also stop complaining.
Tom:
I totally agree, I had acupuncture treatment on the advice of an MD as alternative to an unexplained muscle pain in my shoulder. Well the pain went away and never came back.. You know if sticking a needle in you does it then so be it.. All I cared was that my twing went away and never came back!
Dennis
Tom,
That’s a curious way to read the study. The study found that BOTH real and sham acupuncture produced pain reduction in a statistically significant percentage of the subjects. Does the fact that sham acupuncture produced slightly higher reductions of pain establish that the efficacy of real acupuncture is nothing more than placebo?
I don’t think that follows. It might be the case, but it could also be the case that “real” acupuncture does have some analgesic effect, though this effect is certainly likely to be augmented by the placebo effect.
More importantly, however, so what if the analgesic effects of acupuncture is nothing more than a placebo effect? It reduces pain, doesn’t it, and quite effectively at that? Isn’t that the bottom line — we want to reduce suffering? Too many people understand the term “placebo effect” as ‘not real medicine,’ which is absurd for a variety of reasons, not least of which is that some of the most promising research on intractable pain (a very small percentage of pain, actually) suggests that the placebo pathways are crucial to finding ways to ameliorate such pain.
Far from criticizing interventions that take advantage of the placebo effect, then, I tend to think we should embrace the demonstrated efficacy of placebo-based interventions for relieving pain. In many cases, placebos actually work better than standard biomedical interventions, and if reducing human suffering is what we are after, we should pay close attention.
Daniel, even though I’m skeptical of acupuncture and chiropracty, I certainly would never advocate that regulations should prevent consumers from availing themselves of such practices. The thornier issue, it seems to me, is how such practices and research into them should be financed. For example, should regulators require medical insurers to cover acupuncture and chiropractic services in the same manner as conventional medical services? Similarly, should such practices have the same entitlement to the research funding from governmental sources as conventional medical research?
Tom,
I’m not sure I understand. If there is solid evidence that acupuncture or other CAM procedures actually work to reduce pain, what is the justification for refusing to cover them? That they are not Western in origin? That they are produced in non-allopathic models of healing?
Shouldn’t our primary concern be the reduction of human suffering? And if there is good evidence that many kinds of CAM unquestionably do reduce suffering — as the study you cited also supports — I’m not sure I understand the justification for refusing to reimburse or allocate funding. The NIH, for example, has a National Center for Complementary and Alternative Medicine (http://nccam.nih.gov/). M.D. Anderson, no bastion of medical liberalism, has a robust CAM department, and is currently doing a lot of good work on the beneficial effects of many different CAM therapies for cancer patients.
If the therapies are evidence-based, and the placebo effect is an excellent pathway for ameliorating pain, I see no reason why they should not be covered and funded.
Perhaps your argument makes sense as to government-administered medical insurance. But why shouldn’t a private insurer, willing to take the market risk of providing such insurance, not be given the flexibility to reduce premiums for their customers by seeking a pool of insureds who do not desire coverage for chiropracty or acupuncture?
Well, I never said anything about compelling insurers to cover such procedures, any more than insurers should be obligated to cover any other evidence-based procedure. I simply wanted to point out there is excellent evidence for a variety of CAM procedures, including acupuncture and chiropracty. Individuals can choose what treatments they wish to avail themselves of, which is fine. But I think a commitment to practicing evidence-based medicine cannot fairly be limited to those healing practices of Western origin, with no other justification.