It is possible that the practitioner might act subtely differently and give "clues" during the sham procedure. But remember that the subjects are naive to acupuncture, and only get one procedure or the other so would not be able to pick up the subtle differences in treatment. It is not analogous to clever Hans or the Prime Minister.
In medical trials whoever is responsible for the RANDOMIZATION cannot be the one that gives the medicine but they also are not the ones doing the evaluating. The researchers that evaluate the results dont know which arm the subjects were randomized into so they are blind, as are the patients.
And in fact this is how it is done in those acupuncture trials that I referenced for you earlier. A true acupuncure arm, and a sham acupuncture arm. In general there is no statiscally significant difference between the two.
----- 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 7:46 PM
Subject: Re: Alternative Medicine (was Re: Skepticism - its uses and abuses)
On 12/22/05, jack syme <drsyme@cablespeed.com> wrote:
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?
I'm not sure it would qualify as placebo controlled. The problem is that the practitioner giving the sham treatment would know that it was a sham and thus might unwittingly give psychological cues to the patients. My understanding of double blind procedures is that e.g. in drugs, the doctor prescribing the drug must not know which patient gets the placebo and which gets the drug.
My friend who claims to be "electrosensitive" cites an oft-quoted case of the Norwegian Prime Minister who claims she is affected by mobile phones, even when they are not in use - (when they don't emit radio waves except about once an hour to give a homing signal). The basis of the Norwegian Prime Minister's claim is that she'd had friends come into the room with a mobile phone concealed in their bag, either switched on or off. She says she can tell when the phone is switched on. My objection to this procedure is that the person carrying the bag in knows the state of the phone, and will unwittingly give the game away. This effect was noted in the 19th Century with the horse called "Clever Hans" who could do arithmetic. You'd ask it a question and it would stamp its feet the correct number of times to give the right answer. It was found that it didn't have to be the horse's trainer who asked the question - it would work with anyone, provided the horse could see the "questioner", and the "questioner" knew the answer. Otherwise the horse couldn't get the right answer. The explanation was that the horse picked up on the tension, or facial expression of the "questioner", when it had stamped its feet the right number of times.
Hence, with these effects so well established, I think it would not work to give a sham acupuncture if the practitioner knew it was a sham.
Iain
----- 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.
--
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After the game, the King and the pawn go back in the same box.
- Italian Proverb
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After the game, the King and the pawn go back in the same box.
- Italian Proverb
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Received on Thu Dec 22 23:01:10 2005
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