A sharp difference: Study of sham vs real acupuncture appear good or bad depending on how you view it

One research paper, two rather significantly different media reports. What’s the deal with acupuncture?

The Guardian puts it this way:
Data indicates treatment is more than a placebo, but differences between true and sham acupuncture are modest.

USA Today puts it this way:
Acupuncture gets a thumbs-up for helping relieve pain from chronic headaches, backaches and arthritis in a review of more than two dozen studies.

Why the difference? Some people REALLY want acupuncture to look credible.

Tip: @toxicpath and @skeptinquiry on Twitter

From USA Today:

The new analysis examined 29 studies involving almost 18,000 adults. The researchers concluded that the needle remedy worked better than usual pain treatment and slightly better than fake acupuncture. That kind of analysis is not the strongest type of research, but the authors took extra steps including examining raw data from the original studies.

The results “provide the most robust evidence to date that acupuncture is a reasonable referral option,” wrote the authors, who include researchers with Memorial Sloan-Kettering Cancer Center in New York and several universities in England and Germany.

Their study isn’t proof, but it adds to evidence that acupuncture may benefit a range of conditions.

Ugh. It’s a meta-analysis sponsored by the National Center for Complementary and Alternative Medicine and the Samueli Institute, a non-profit group that supports research on alternative healing. So, there’s some bias there. The USA Today version of the story provides a bit from Quackwatch‘s Dr. Stephen Barrett who notes the results are dubious but the rest of the article is a feel-good commercial for acupuncture as a wonderful thing. It’s pretty awful.

The USA Today piece also notes:

But some doctors believe even if [placebo effect is] the explanation for acupuncture’s effectiveness, there’s no reason not to offer it if it makes people feel better.

Er… YES there is good reason not to offer it. See this earlier story!

In contrast the Guardian version quotes Edzard Ernst:

Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study “impressively and clearly” showed that the effects of acupuncture were mostly due to placebo. “The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely.”

Ernst added that a potential problem with the trials in the meta-analysis was that, in all cases, the therapist knew whether he or she was administering real or sham acupuncture. “Arguably, it is next to impossible to completely keep this information from the patient.

This is a problem with acupuncture studies. The effects are so small between real and sham that they can be attributed to something other than the effectiveness of real acupuncture. Shouldn’t there be a BIG difference if real acupuncture was, well, real? Yes. But there isn’t. So to risk your health by putting needles in is NOT worth it. Go with the sham acupuncture. Better yet, find something truly relaxing like a massage, no needles involved. Much less risk.

Shame on you USA Today and NCCAM. Shoddy science, shoddy journalism.

UPDATE: As I expected, an analysis from Orac and a piece from Science-based Medicine.

More:
Acupuncture revisited
Acupuncture: Disconnected from Reality

There is so much more in the skeptical literature about acupuncture and why it fails as a real treatment. Take a look at the whole section of science-based medicine, of which acupuncture is not.

For a great talk about Fairy Tale science and placebo medicine, check out Dr. Harriet Hall’s talk from the World Skeptic Congress here.

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  7 comments for “A sharp difference: Study of sham vs real acupuncture appear good or bad depending on how you view it

  1. Geoff
    September 12, 2012 at 8:53 AM

    The lay public are really in the dark as to what the placebo effect is. It is essentially NO effect. At best, it make people feel better. Note, that’s feel better. When objective measures are used, there’s no change.

    I wonder who these “some doctors” are that would recommend using an invasive procedure with substantial risk of side effects to get an ameliorative placebo effect. My guess is that they are probably not real doctors, but chiropractors, naturopaths, or some other supplementary/complementary/alternative medical (SCAM) provider.

  2. Kristi St.Clair
    September 12, 2012 at 9:33 AM

    I’m a physician, and I have lately been deeply pondering the ethical ramifications of the placebo effect. Yes, the placebo effect is essentially no effect, and we are compelled by the principles of informed consent, patient autonomy, and intellectual honesty to say so. On the other hand… placebo relief is still relief! For all those people who feel better because they believed in their acupuncture (or antidepressants, the other bothersome placebo issue), do we really do them any benefit by bursting their bubble and taking away all the good effects of their placebo? I wish that we could harness the power of the placebo effect to give people that same benefit without the colossal expenditure of money and risk of side effects involved in these treatments. I suppose that’s one thing that homeopathy has going for it… if you’re going to invest faith and money in a placebo, there’s something to be said for investing in something with no more side effects than memory water!

    • Vin
      September 13, 2012 at 7:21 PM

      where’s your Practice?….I’ll be sure to NEVER visit.

    • September 18, 2012 at 5:13 AM

      So why not make the doctor the agent of the placebo effect? “Bedside manner” is the best source for the increase of a patient’s “feeling better”. Touch the forehead to feel for temperature… that’s a mother’s touch, a source of comfort, a relinquishing of the beleageured sufferer of their trembling struggle, their relaxation into “being cared for”, the tapping into the sensation of protection by a benevolent authority figure…. it’s up to you to inspire that placebo effect, not to con the patient with a bogus modality and a virtually supernatural appeal to mystery. I also would not want a doctor who decides to use fake medicine instead of simply giving compassionate and honest attention.

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