Re: Alternative Medicine (was Re: Skepticism - its uses and abuses)

If patients were given acupuncture according to the meridian theory by a capable practitioner, and another group of patients was given sham acupuncture (same types of needles, same number of sticks, but in different places) by the same practitioners, but the patients didnt know which treatment they got, and, the people that were evaluating the responses didnt know which treatment the patients got (the evaluators do not have to be the same as those that are doing the procedure), wouldnt this qualify as double blind placebo controlled?
  ----- Original Message -----
  From: Iain Strachan
  To: jack syme
  Cc: Michael Roberts ; chmorl@wm.edu ; D. F. Siemens, Jr. ; asa@calvin.edu
  Sent: Thursday, December 22, 2005 8:57 AM
  Subject: Re: Alternative Medicine (was Re: Skepticism - its uses and abuses)

  Jack,

  This does raise some interesting points. After reading Michael's post, I checked out acupuncture on Skepdic.com http://skepdic.com/acupunc.html and found that they argued that it was most likely to be a placebo effect. The whole problem with any medical treatment is that the claim "it works for me" (it worked for Michael) is not scientific - acupuncturists claim it works by unblocking chi energy (or whatever), a concept that has no scientific backing. The fact it works for you is just as easily explained by the placebo effect as it is by saying it's directly the acupuncture (cf my earlier experiences with the Buteyko method for asthma, which I now put down to placebo).

  However, it's been around for thousands of years, and Jack's point that maybe we don't know why it works is a good one. It _might_ be placebo, but it could be due to an as yet to be discovered phenomenon. I think David's point is also valid, that traditional remedies are likely to be superior to wacky modern techniques. Although these remedies may work for unknown reasons, I guess the principal of natural selection applies here. Ancient people may have tried all sorts of random weird ideas to cure people (like waving chicken entrails over someone), and there is a chance that some random things tried will work, and those are the ones that are still with us today.

  I think that maybe "skeptics" perhaps overlook this possibility - they tend to write off everything that doesn't have tested scientific evidence (double-blined trials etc), when in fact it _could_ be that something that has stood the test of time works for an unknown reason.

  It struck me that there could be a blinded trial that might demonstrate if acupuncture is down to placebo, however. As I understand it, acupuncture has to be done (according to tradition) by putting in the needles at "meridian" points, something that has little scientific backing. So suppose you had a trial where the "placebo" was to insert needles into places that weren't meridian points, and the other half used the known meridian points. Then if those on the placebo fared just as well as the others, it would conclusively disprove the meridian theory. The difficulty of doing this would be to make it "double-blinded"; the person sticking in the needles would have to be unaware of whether it was a meridian point or not. You would have to train up volunteers from scratch to administer acupuncture on a number of points, some of which were meridians, and some of which weren't & then assign randomly who used which points. I would have thought it could be done though in a carefully controlled way.

  Iain

  On 12/22/05, jack syme <drsyme@cablespeed.com> wrote:

> On chinese medicine I am convinced by acupuncture. I have a bad neck - I
> can hear grinding when
> I turn my head! It's been stretched massaged but acupuncture helped. I
> only tried it as nothing worked. However there are good reasons why it
> works.
>

    This is exactly the issue I struggle with. Yes acupuncture can work. But
    why does it work? What are the good reasons why it works? As far as I know
    there is no anatomical correlate for meridians, and no physiological
    correlate for qi.

    My professional opinion of acupuncture is that it works by some mechanism
    that is not at all well understood. And most likely has nothing to do with
    qi and meridians. There might be a real effect on neuropeptides, some
    unkown effect on nervous system function, or it might all be placebo effect.
    But, the risk of being needled is very small. So if someone can find relief
    from a chronic ailment such as headaches, neck and back pain, without side
    effects then just because its mechanism is not well understood is no reason
    not to recommend it.

    But, is the fact that the underlying philosophy of acupuncture Taoist a
    reason not to recommend it to Christians? And should I as a Christian
    physician not recommend it for those reasons? Similar questions can be
    raised about kundalini yoga, vedic medicine, meditation techniques, etc. I
    have up to this point taken the approach that the underlying worldview that
    acupuncture is based on is so far removed from the practice of it, that
    there is little reason to believe that undergoing acupuncture was sinful.
    And it is likely that the traditional explanation of how acupuncture works,
    is in fact false.

  --
  -----------
  After the game, the King and the pawn go back in the same box.

  - Italian Proverb
  -----------
Received on Thu Dec 22 12:07:50 2005