Why acupuncture is giving sceptics the needle

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Acupuncture has been prescribed by half of Britain's doctors, but after 3,000 clinical trials its efficacy remains unproven. So is the NHS making a grave error in supporting this ancient treatment?


You can't get crystal healing on the NHS. The Department of Health doesn't fund faith healing. And most doctors believe magnets are best stuck on fridges, not patients. But ask for a treatment in which an expert examines your tongue, smells your skin and tries to unblock the flow of life force running through your body with needles and the NHS will be happy to oblige.

The government declines to say how much the health service spends onacupuncture each year, but it's estimated to be around £25m. The NHS rationing body, the National Institute for Health and Care Excellence (Nice), says that doctors can prescribe acupuncture for lower back pain and chronic tension headaches. The NHS Choices website says there is "reasonably good evidence" that acupuncture is effective at treating a range of conditions, including back pain, dental pain, headache, nausea after operations and osteoarthritis of the knee. And there are plenty of anecdotes from patients who swear it works.

Of all the branches of complementary and alternative medicine, acupuncture has without doubt the most credibility among doctors and health officials. Not everyone is convinced, however.

Written By: David Derbyshire
continue to source article at guardian.co.uk

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  1. Maybe offering reimbursement for a treatment method with no more efficacy than the placebo effect, is valid? To those people helped/cured by their own imagination, this could be quite fair. I often wish that I were not aware of the psychology behind the ruse. Once doubt has set in, there’s no way it can work.

      • In reply to #3 by Sjoerd Westenborg:

        In reply to #1 by Nitya:

        I often wish that I were not aware of the psychology behind the ruse. Once doubt has set in, there’s no way it can work.

        Well, actually…

        Wow! Well, they’re certainly cost effective …..assuming the price in not inflated by the woo factor.

    • In reply to #1 by Nitya:

      Maybe offering reimbursement for a treatment method with no more efficacy than the placebo effect, is valid? To those people helped/cured by their own imagination, this could be quite fair. I often wish that I were not aware of the psychology behind the ruse. Once doubt has set in, there’s no way it…
      It works and I’m the biggest sceptic you could meet. I need proof of everything and when I take any medicine or get any treatment I never believe it will work but after just one session my chronic lower back pain was relieved by at least 65 to 70%. Also, even though I never asked for help with it, the “painful bladder syndrome I suffer with went, YES WENT after 1 session alone. I am still in shock after suffering for many years because nothing ever worked. Not even Codine worked on my pain! so…

      • In reply to #22 by JadeLByrne:

        In reply to #1 by Nitya:

        Maybe offering reimbursement for a treatment method with no more efficacy than the placebo effect, is valid? To those people helped/cured by their own imagination, this could be quite fair. I often wish that I were not aware of the psychology behind the ruse. Once doubt has…

        I suggest you click on the link in answer #3. Sometimes response to the placebo effect can work even when one is aware that it’s a placebo! The brain is capable of very strange things.

    • In reply to #1 by Nitya:

      Maybe offering reimbursement for a treatment method with no more efficacy than the placebo effect, is valid? To those people helped/cured by their own imagination, this could be quite fair. I often wish that I were not aware of the psychology behind the ruse. Once doubt has set in, there’s no way it…
      http://www.youtube.com/watch?v=41vm87qq1KU
      This is proof! Trials have been carried out :)

      • In reply to #24 by JadeLByrne:

        In reply to #1 by Nitya:

        Maybe offering reimbursement for a treatment method with no more efficacy than the placebo effect, is valid? To those people helped/cured by their own imagination, this could be quite fair. I often wish that I were not aware of the psychology behind the ruse. Once doubt has…

        I’m currently 1/3 the way through the video. One important point that I’d like to mention so far is that the woman having heart surgery was also sedated and her chest was numbed. They would be the big worries for me, if I were having any sort of surgery. I would also like to think that my body has been immobilized by the GA, but I think this goes a long way towards accounting for its success. I find the “QI” bit to be complete woo.

      • In reply to #24 by JadeLByrne:

        In reply to #1 by Nitya:

        Maybe offering reimbursement for a treatment method with no more efficacy than the placebo effect, is valid? To those people helped/cured by their own imagination, this could be quite fair. I often wish that I were not aware of the psychology behind the ruse. Once doubt has…

        I’ve watched the complete video now and must say that I was pleasantly surprised. The trial appeared to be conducted really well ( in measuring the brain’s response to deep vs shallow needle insertion). Not what I expected at all. There are questions I’d like to ask, such as the length of time the neurons are deactivated after the needles are removed? If this was for a very short timespan I don’t think the treatment could be classed as a complete success. Thanks very much for the vid.

  2. When I had the right medial cartilage removed from my knee the physiotherapist offered to give me acupuncture but made it clear that she wasn’t sure whether it actually worked; that was in 1975!

    My estimation? I would have recovered anyway! And, at least I got the “treatment” gratis and in the nurses own time in her flat, so no pressure or cost was put on the NHS.

    But my recovery wasn’t helped by a stitch having been left inside my joint, which took about four months to work its way out via a pussy lesion.

    • In reply to #2 by Stafford Gordon:

      But my recovery wasn’t helped by a stitch having been left inside my joint, which took about four months to work its way out via a pussy lesion.

      What?…Sorry, I misinterpreted the end of your sentence with a homograph of the next to last word. haha.

      giggity

  3. According to Ben Goldacre there’s only a relatively low proportion of medical treatments that are supported by reasonable scientific evidence of their effectiveness. Say that’s 60% of medical treatments being scientifically justifiable.

    This leaves around 40% which aren’t. But included in that 40% of wasted public health expenditure is a few $millions for useless acupuncture.

    So you could argue that the annual expenditure for conventional medicine is about $100b more wasteful than for expenditure on acupuncture. i.e. around 4000% worse.

      • Obviously they don’t need a reason to fund acupuncture.

        It might also be a good idea if they eliminated funding for various other activities that contribute nothing more to medical practise than the placebo effect . E.g. Golf and country club memberships, prestige cars, and other essential physician expenditures associated with the medical profession. The placebo effect of these therapies is obviously highly valued by stressful practitioners, otherwise they wouldn’t be so addicted to them. But public health is supposed to be about value for money.

        In reply to #6 by Bigtimedwarfer:

        In reply to #5 by Pete H:

        Is that a reason to continue funding acupuncture?

        • In reply to #8 by Pete H:

          It might also be a good idea if they eliminated funding for various other activities that contribute nothing more to medical practise than the placebo effect . E.g. Golf and country club memberships, prestige cars, and other essential physicia…

          I find your posts quite oblique. Are you now suggesting that the NHS should prescribe what their staff spend their salaries on but not restrict their therapy budgets to treatments that are actually effective?

          • In reply to #13 by Bigtimedwarfer:

            The previous 4 posts I replied to from Pete H were pretty standard (pathetic) conspiracy crap, he has yet to respond…. I think he’s from the “I don’t know the answer, but I’m just saying there might be a conspiracy” loony fringe but I’m still holding out for a drop of sense.

            So far; just a wanker.

            In reply to #8 by Pete H:

            It might also be a good idea if they eliminated funding for various other activities that contribute nothing more to medical practise than the placebo effect . E.g. Golf and country club memberships, prestige cars, and other essential physicia…

            I find your posts quite o…

          • A conspiracy might be one explanation. Generally you need many people with some kind of secret plan to employ information asymmetry for direct or indirect financial exploitation.

            No such secret plan is required here. The interests of the players are so obvious that there is no need to coordinate and conspire. Which doesn’t mean that it might not happen. But the situation can be easily explained without conspiracy.

            Most medical treatment expenditure is at the cart end of things, not the horse. Many disease treatments are getting more effective. E.g. Better prospects for short and medium term trauma stabilisation following heart attacks and strokes. But more people are getting sicker, e.g. more are likely to become affected by risk of heart attack and stroke, diabetes or Alzheimer’s etc. despite the inexorable escalation of expenditure on public health.

            The main area of disease growth is in the area of non-communicable diseases. Interestingly there are frequent reports now that the pharmaceutical industry tends to be moving away investment in tackling traditional infectious diseases, which otherwise respond to antibiotics. Which leaves vaccinations as the main approach to preventative medicine. But they’re not much use for non-communicable diseases.

            It should be no surprise that there’s public demand to introduce new treatments. No matter how ineffective or lack of evidence-basis. Though this is likely to be about as effective at things like the ‘occupy wall street’ campaign, for similar reasons.

            Yes, the numbers are probably meaningless. Ben Goldacre or anyone else can only guess at the actual numbers of effective versus ineffective treatments, and the real motive for funding or recommending particular treatment options. The reference frame, methodology, and definition of referent groups for benefit cost analysis is normally more political than than scientific. I’m just pointing out that there are probably a lot worse things happening in the medical industry than some alternative therapies being funded at public expense. There’s a great deal more being funded at public expense that is equally ineffective, just not branded as ‘alternative’.

            If I was a conspiracy minded person I’d probably suggest that this kind of thing occasionally slips through to give the industry authorities something to pretend to deal with, keep the masses distracted while ignoring the real issues. Something of a smokescreen. The role of the skeptics as useful idiots in this process then becomes more obvious.

            The established argument for the assumption of a conspiracy in days of Roman Law was ‘cui bono’. We’re in a world where the wealthiest people with the highest incomes tend to mostly be players within or on the periphery of the financial broking and banking world. Yet their area of specialist expertise is currently mired in the biggest financial crisis in history, with no positive outlook yet in sight 6 years later. Pretty much the same phenomenon is apparent the medical world with the global NCD crisis.

            It may also be no coincidence that he quality of science in the fields of public health and macroeconomics seem to be the outliers compared to all other sciences.

            An important reason many kids take science course options seems to be because their parents want them to have a crack at qualifying for admission to medical school, perhaps because it’s a slightly more accessible high status profession than inheriting the role of being a multimillionaire bank director. It isn’t because they think a scientific outlook is valuable or that they expect their kids to get jobs as scientists. (There really aren’t many jobs going in science, and most people in the real world are less than impressed with a scientific approach to anything.) It could never happen because the established interests are so entrenched, but if the balance ever shifted strongly towards public health funding for alternative medicine then those same ‘scientifically trained’ kids will be queuing up for homeopathy and acupuncture school. No conspiracy required for this to happen. Just a motive to follow the money. (Though the preferred option will always be to become the guy that prints the money in the first place, or his close friend.)

            Same complete absence of conspiracy happens with economics theory, where the students line up to be taught that western civilisation will collapse unless the financial sector continually prints money and then pays itself with it. It’s very difficult to convince someone of something for which their job depends on their not understanding it.

            In reply to #14 by alaskansee:

            In reply to #13 by Bigtimedwarfer:

            The previous 4 posts I replied to from Pete H were pretty standard (pathetic) conspiracy crap, he has yet to respond…. I think he’s from the “I don’t know the answer, but I’m just saying there might be a conspiracy” loony fringe but I’m still holding out for a d…

    • In reply to #5 by Pete H:

      With the greatest respect for Ben Goldacre you have murdered any reality in those numbers and he would not approve, this is not what it’s about. What you say is important don’t start from a vague memory and wildly extrapolate.

      According to Ben Goldacre there’s only a relatively low proportion of medical treatments that are supported by reasonable scientific evidence of their effectiveness. Say that’s 60% of medical treatments being scientifically justifiable.

      This leaves around 40% which aren’t. But included in that 40%…

    • In reply to #5 by Pete H:

      According to Ben Goldacre there’s only a relatively low proportion of medical treatments that are supported by reasonable scientific evidence of their effectiveness. Say that’s 60% of medical treatments being scientifically justifiable.

      Source, please. A quick Google search did not support your claim.

      • Ben Goldacre has a web site and has written a couple of entertaining books on the topic of medical quackery. Enough to make him something of a target for libel harassment.

        Though he isn’t a scientist and doesn’t claim to be one. He’d probably better known in the UK than elsewhere.

        On the other hand, he’s quite critical of many who do claim to be scientists. Medicine is mostly a serious and very lucrative business. It can be a mistake to assume that just because aspects of medicine are based on science then it is in the overall industry’s interest to fully embrace science. As with any business the customer ultimately gets what they demand. Whether that be antibiotics for every occasion, performance and appearance affecting substances, or alternative therapies.

        I blame the junkies, not the dealers.

        In reply to #21 by WayOfTheDodoTwo:

        In reply to #5 by Pete H:

        According to Ben Goldacre there’s only a relatively low proportion of medical treatments that are supported by reasonable scientific evidence of their effectiveness. Say that’s 60% of medical treatments being scientifically justifiable.

        Source, please. A quick Google sear…

    • In reply to #9 by Roedy:

      It does work at an alternative to dental anaesthesia does it not? The problem with it is likely claims in areas where it has no effect.

      Where did you find evidence for that Roedy? I’ve found studies describing acupuncture for dental analgesia (mainly for facial pain syndromes) but only one from 1979 for use in operative dentistry that is more than a non-controlled case series. It points out that the placebo group had just as fun a time as the treatment group and that procedural acceptability in both groups was probably due to placebo effect + modern high-speed drills.

    • In reply to #9 by Roedy:

      It does work at an alternative to dental anaesthesia does it not? The problem with it is likely claims in areas where it has no effect.

      Does it? I would not have thought so. Dental pain is pretty hard to magic away.

    • In reply to #9 by Roedy:

      It does work at an alternative to dental anaesthesia does it not? The problem with it is likely claims in areas where it has no effect.

      Yes, and is also used as an alternative to anaesthetic in some hospitals but mostly in Shang hai and other parts of China. In this video you wll see them preform open heart surgery on a patient using only Acupuncture! she was awake too! she choose this because it costs 1/3 the price of anaesthetic.

  4. In 2000, a British Medical Association survey showed that around half of doctors had prescribed acupuncture in the UK.

    Translation from the original text:

    In 2000, a random-sample survey of the proportion of the 26,000 (at the time) UK General Practitioners (so not all doctors) who happened to be members of the trade union the British Medical Association (so not all GPs) was conducted. Of the 365 that could be bothered to reply (therefore with self-selection bias in spades), 169 said they’d arranged acupuncture treatment for a patient (in 15% of cases, doing it themselves and in 57% referring to another doctor). 58% of the 365 had arranged CAM of some kind with homeopathy and osteopathy being the next most popular referrals.

    Hardly a sweeping recommendation by the UK medical professional…

    • In reply to #17 by Docjitters:

      In 2000, a British Medical Association survey showed that around half of doctors had prescribed acupuncture in the UK.

      Translation from the original text:

      In 2000, a random-sample survey of the proportion of the 26,000 (at the time) UK General Practitioners (so not all doctors) who happened to be…

      I once visited a GP, who kept a large crystal in a very visible spot in the surgery. I guess she was covering all bases.

  5. ever since childhood i have never been able to bend & ouch my toes i sought advice from a local acupuncturist and was told that this tightness i experienced would undoubtedly be ameliorated “freeing up the energy flow in my main meridian” various words and ideas like that. an extensive and expensive course of acu mainly in my feet had no effect whatsoever. Later i had sessions with an Ida Rolf physiotherapist who told me that i simply had short muscles and short tendons and nothing can ever change that physical fact
    the acupuncture if found to have a strangely captivating rather addictive quality, anticipating the little frisson of pain a certain adrenalin effect perhaps akin to retching effect in bolemia or anal sensations ( addictive qualities of foot sensations r explored in the film Riase the Red Lantern) I.V. drug addicts cite an addictive quality in the needle culture. acu a highly addictive little pain ritual ?

  6. In reply to #5 by Pete H:

    According to Ben Goldacre there’s only a relatively low proportion of medical treatments that are supported by reasonable scientific evidence of their effectiveness. Say that’s 60% of medical treatments being scientifically justifiable.

    This leaves around 40% which aren’t. But included in that 40%…

    http://www.youtube.com/watch?v=41vm87qq1KU

    I think they do right spending on it. It definitely works in some areas. watch!

  7. Just a comment. My father was a reconstructive plastic surgeon, and a sceptic. He is religious, but that is beside the point. He travelled to China in the early 1980′s, when it was still a closed country. While there giving lectures on reconstructive surgery (mostly maxilofacial reconstructive surgery – basicly putting faces back together after major trauma) he was invited to observe cardiac surgery with accupuncture as the anaesthetic. He watched open heart surgery of a middle aged woman, who remained awake, and talkative, throughout the surgery. He was always sceptical of accupuncture and grouped it with such quackery as iridology, reflexology and astrology. This changed his mind. Science is wonderful. We may not understand it, but the experiment showed something was going on. He does not offer an explanation, but believes it may have some validity as a nerve blocking procedure. Mind you, I have reservations about the teaching of the practice in the west.

  8. This is an intersting article in our Australian papers. There was a poll held after this to see what people thought about alternative medicine.
    http://www.smh.com.au/federal-politics/the-question/should–universities–teach–alternative–medicine-20120203-1qxb3.html
    It was then found the poll was manipulated to show a no vote!
    http://www.smh.com.au/technology/technology-news/alternative-health-poll-exposes-malaise-20120210-1sg9v.html

  9. I’m pretty skeptical that acupuncture actually does anything more than would otherwise occur via just paying close attention to someone. (Something which shouldn’t be underrated e.g. hypnotism.) Has anyone stumbled across or looked into the phenomena of ASMR?

    From what I understand it’s something that most people who experience ASMR never really considered it as being unusual or significant until it began to be mentioned on the Internet, and ended up with a name recently. Something that might never have come to awareness if not for internet blogs.

    It seems to be something of a reverse acupuncture experience. Positive tingling sensations on the skin driven by one’s mental state, usually in response to close personal attention. Similar, but different, to the more negative effect of the skin prickling with apprehension. Often occurs in response to musical passages, tone of voice, situation, peculiar sounds, grooming behaviour etc.

    ASMR seems to have a few aspects in common with acupuncture like the tingling effect defining lines of meridians etc. Maybe it’s possible that acupuncture originally arose as a practise attempting to trigger ASMR responses – which are regarded as particularly relaxing and positive experiences. Maybe relevant to healing via stimulating the immune system via some connection with the placebo response.

  10. In reply to #9 by Roedy:

    Does it ? I have had some pretty major dental surgery in the last two years. apicoectomy, bone grafts, extractions – Pretty uncomfortable and sometimes painful experiences. If you are volunteering to go through this with a few needles stuck in your arm, then go for it.

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