I must confess, I had a rather rough time yesterday. Actually, it's been a rough winter, at least as far as my car is concerned. Record amounts of snow and a January much colder than usual have wreaked havoc on the roads around where I live, producing craters that make our roads and freeways look more like the surface of the moon than anything you'd want to go speeding along on in an automobile. So it was that about a month ago on my way to work I couldn't avoid a particularly nasty crater, and immediately after I hit it I knew something was wrong. My tire pressure light went on, and the car started handling sluggishly. Yes, sure enough, I had the first flat tire I had had in a very long time—many years. The damage was too bad, and I had to replace the tire, although, fortunately, the rim was fine. Even more fun, it was one of the coldest days of the year (up to that point). So what should happen last night on my way home from work? Yep, you guessed it! I hit another pothole and blew out another tire. Worse, it was along a stretch of freeway that, trust me, you don't want to get off of to go into the surrounding neighborhoods. Those of you who know which metro area I live in know just how bad those neighborhoods can be. Eventually I got some help and managed to get home but that was a—shall we say?—less than pleasant experience.
So as I write this I'm tired. Yet, at the same time, I'm a bit amused. I've made fun of what happens when a quack gets a hold of a microscope and uses it to look at everyday food (like chicken nuggets), expressing amazement that things look really strange when magnified. It was so hilariously precious. Then a real doctor made epic pronouncements based on looking at a single chicken nugget under the microscope and expressing amazement that there is vascular and nerve tissue in there. This study is a bit different in that, for once, it's not food being looked at under the microscope. Also, here we're talking scanning electron microscope images, not regular old light microscopy. What makes this study silly is not so much that the scientists doing it misinterpret or overinterpret what they see. Rather, it's that they bothered at all to do such an utterly pointless experiment. You'll see what I mean in a minute.
I became aware of this study when a news story popped up on my news feed, Research examines acupuncture needle quality, which spinned the story thusly:
The quality of needles used in acupuncture worldwide is high but needs to be universally improved to increase safety and avoid potential problems such as pain and allergic reactions, RMIT University researchers have found.
The researchers looked at surface conditions and other physical properties of the two most commonly used stainless steel acupuncture needle brands.The study, published in Acupuncture in Medicine today (13 February), found that although manufacturing processes have improved, surface irregularities and bent needle tips have not been entirely eliminated.
From the article and the study, which is open access, meaning that you, too, can be amused the way that I was, you'd almost think that we were dealing with an actual medical device that's worthwhile. In fact, this study is perhaps the most blatant example of what Harriet Hall refers to as "Tooth Fairy science" I've seen in a very long time. She dubbed such science "Tooth Fairy science" because you can study the amount of money left by the Tooth Fairy in different settings, but since it's never been established that the Tooth Fairy actually exists, any conclusions will be, as Hall puts it, "falsely attributed to an imaginary being than to the real cause." The analogy to acupuncture is obvious, because with acupuncture, we are studying an elaborate, ritualistic placebo effect, rather than any sort of "life energy" or "qi" being used to healing effect. This study is taking Tooth Fairy science to a new level by subjecting acupuncture needles to various tests, the assumption being that it matters to the therapeutic effect that the acupuncture needles have certain characteristics. When it doesn't matter whether the acupuncture needles are inserted into the "real" acupuncture points or sham acupuncture points and twirling toothpicks against the skin does as well as real acupuncture needles, that is an assumption that is unwarranted. Yet, here we are.
It's clear from the very beginning that the investigators are True Believers. You can tell just from the way the introduction is written:
Acupuncture is a therapeutic modality that involves inserting needles into certain points of the human body. It has been used in clinical practice for thousands of years and is currently being practiced globally.1 ,2 In modern China, traditional Chinese medicine including acupuncture accounts for 40% of medical treatment,3 while in Western countries acupuncture is one of the most frequently used complementary/alternative therapies.4–8
The use of acupuncture can perhaps be traced as far back as the Stone Age (around 3 million years ago) in ancient China, using the Bian Shi (sharpened stones) to stimulate certain points on a patient's body to achieve therapeutic effects. The use of Bian Shi was followed by fine needles made of other materials such as bamboo, ceramic, bones, the thorns of plants, the beaks of birds and metals (including gold, silver, bronze and, more, recently stainless steel).1 ,2 ,9 Modern-style acupuncture related therapies can be applied via a range of equipment including needles, acupressure pellets and electrical or laser stimulation. However, among all these forms of treatment needling acupuncture involving skin penetration is the most frequently used method, in China and in other countries. It is estimated that 1.4 billion acupuncture needles are used each year worldwide.10
Wow! Not content to parrot the usual line about acupuncture being 2,000 or more years old, these guys push it back far, far into prehistoric times. Heck, they push it back to times before modern humans had even evolved from their hominid ancestors! After all, Homo sapiens first appeared only around 200,000 years ago, and even Homo erectus only appeared approximately 1.8 million years ago. Three million years ago, the hominid ancestor of modern day human beings that predominated was Australopithecus africanus, which lived in Africa between 3.3 and 2.1 million years ago. While it's true that Australopithecus made and used simple stone tools, I had no idea that these hominids could use sharpened stones to heal themselves, although if they did it would mean that acupuncture actually developed in Africa, not China. Even worse, let's just, for the sake of argument, accept that Australopithecus did acupuncture using sharpened stones. If that's the case, how on earth would paleontologists know that that's what these hominids used putative stone acupuncture implements for? It's not as though there was writing, or anything, and it's not as though such implements would be likely to look a lot different from stone blades and other common tools. The whole assertion is just so incredibly stupid, and, based on that one assertion alone (that acupuncture dates back 3 million years), the people who oversee all the BMJ journals should hang their heads in shame for allowing this acupuncture journal into their stable of journalse. Burning stupid doesn't even begin to describe it. Thermonuclear stupid starts to get at least in the same solar system. Maybe solar stupid, as in burning stupid as hot as the heart of the sun, would be a decent description of the ignorance embodied in that one sentence.
As has been explained right here on this very blog and elsewhere, no, acupuncture as it is commonly practiced now, is not even thousands of years old. Rather, acupuncture, the way it is practiced now with very thin needles, is probably less than 100 years old, and, in fact, was popularized by Chairman Mao, along with the rest of "traditional Chinese medicine." In reality, acupuncture probably evolved from bloodletting treatments not unlike bloodletting used by medieval healers in Europe that utilized much larger "needles" as cutting implements. This story of the history of acupuncture reads like the history of the Tooth Fairy that leaves out one rather essential element, namely that the money that seemingly magically appears under children's pillows at night when teeth are left there is put there by the children's parents, not some magical Tooth Fairy. Similarly, this history neglects to mention that acupuncture was based on magical thinking, that there is no such thing as "qi," and that sticking needles in the skin doesn't "redirect the flow of qi."
Forging bravely ahead into the depths of pseudoscience, the authors decided to examine the quality of single use acupuncture needles purchased from several different companies. To do this, they examined a random sample of ten needles different brands of disposable acupuncture needles. They even doubled down on the Tooth Fairy science by taking images of these needles after they had undergone a standard manipulation with an acupuncture needling practice gel, at which time they did a comparison of forces and torques during the needling process.
So what did they find? Really, it almost doesn't matter what they found, because this is Tooth Fairy science. Basically they used materials science to study the quality of tools used to practice magic. You can look at the images for yourself to see what they found, but basically the scanning electron microscope (SEM) images revealed what the authors characterized as "significant surface irregularities and inconsistencies" at the needle tips, particular from one brand of needles. They noted "metallic lumps" and "small, loosely attached pieces of material" on the surfaces of some of the needles and that some of the lumps disappeared after acupuncture manipulation, meaning that these small pieces of metal could have lodged in patients, leading the authors to conclude:
If these needles had been used on patients, the metallic lumps and small pieces of material could have been deposited in human tissues, which could have caused adverse events such as dermatitis. Malformed needle tips might also cause other adverse effects including bleeding, haematoma/bruising, or strong pain during needling. An off-centre needle tip could result in the needle altering its direction during insertion and consequently failing to reach the intended acupuncture point or damaging adjacent tissues.
Improving the quality of acupuncture needles and thereby reducing the likelihood of complications are both good things, of course, but what is unspoken (but should be spoken) is that there is no legitimate medical reason to be sticking these needles into people anyway because acupuncture doesn't work. Reducing the risk by encouraging better manufactured needles doesn't change the risk benefit-ratio. The risk-benefit ratio is still infinite, because the benefit in the denominator is still zero. Or, if you prefer to look at it another way, the benefit to risk ratio is still zero because the benefit is zero. The answer is to stop doing acupuncture, not to subject acupuncture needles to SEM.
None of this stops our intrepid band of Tooth Fairy researchers from speculating:
The commonly seen bleeding or haematoma/bruising was possibly caused by unsmooth needle tips breaking small blood vessels during needle insertion. Highly malformed tips were found in several H needles. This could be the reason for the occasional unexplained strong pain in the needling area reported by some patients during acupuncture.9 An off-centre (eg, H10) or an unsymmetrical (eg, H3) needle tip may also cause the needle to alter direction during insertion.9 If the flaws at the needle tip are eliminated through adequate quality control of the needle manufacturing process, such acupuncture needling associated adverse effects may well be reduced.
All of this might be true, but it completely misses the point, again, namely that acupuncture doesn't work; so placing needles into the skin, no matter how low the risk of complications is, is not medically justifiable, at least not if your goal is healing. I realize that people place needles into the skin all the time for various non-therapeutic purposes like tattoos and piercings, but no one claims that tattoos and piercings are medicine. Acupuncturists do claim that their violation of the skin with metal needles is medicine. So the brain trust at RMIT University in Melbourne did an SEM study.
Tooth Fairy science marches on and on.
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Am just sending off letter to NHS England complaining use of tax payers money in our local NHS for acupuncture- this article came at right time. Will forward link.
Here's a thought for Yi Min Xie, Shanqing Xu, Claire Shuiqing Zhang, and Charlie Changli Xue, and I'm just spitballing here, but if you really want to avoid bleeding and bruising from acupuncture needles I'd think there's an obvious solution.
Unlike Orac, I think that materials scientists and industrial engineers examining the quality and imperfections of these needles is perfectly appropriate. Their conclusion that better quality control and manufacturing processes are reasonable given their focus and backgrounds.
Sometimes I wonder why I left FL for the Northeast. Oh yeah, better jobs and schools.
Agree with Mephisto's first point, and second point.
I'm rushing to offer gold-plated supersmooth needles - for an even better theater going experience.
I suggest the author move to that other cancer center slightly west of his if possible - we already have his picture hanging on the wall as you pass from the labs to the cancer center, where worshipers gather.
Never mind Homo Sapiens, Home Erectus first appears in the fossil record 1.8 millions ago. These assclowns don't even rise to the level of maroons.
I suspect that the error caused by the effects of an off-centre needle tip is much less than the precision with which a person can place the needle in the first place. If this is enough to cause the acupuncturist to to miss the meridian, then the meridians are so narrow* that the acupuncturist is going to miss them most of the time anyway.
*the actual width of the meridians is probably less than a Planck length.
Orac - I hope that was your winter beater and not your Ford GT.
D'oh! I was so busy focusing on the acupuncture bit that I failed to notice that.
So embarrassed was I at not noticing that, I couldn't resist adding a paragraph of a bit of fresh Insolence directed at the sheer ignorance embodied in that one sentence.
So conventional medicine accounts for 60% of medicine practiced in China, good to know, though it's far more than you would think judging by what some people write on the subject. Also interesting is the revelation that acupuncture sometimes causes, "bleeding, haematoma/bruising" and especially the "occasional unexplained strong pain in the needling area". "Unexplained"? I can explain it - you stuck a needle in them Einstein! Pain, bleeding and bruising is almost inevitable when break someone's skin with a sharp object for whatever reason, which is why it's best not to do so unless you have a good one, as a general rule.
One wonders, idly, if people get macrophagic myofasciitis from acupuncture - punctured lungs have been reported, so why not? Iron can been found in the brains of young women who have died of strokes. Maybe it was carried to the brain by macrophages from stainless steel left in acupuncture sites by crappy needles. Someone alert Chris Shaw.
It seems to me that a basic tenet of medicine is that a less invasive procedure is always preferrable to a more invasive one if they are equally effective. The fact that twirled toothpicks "work" just as well as needles, yet they still insist on needles that they know put people at risk is proof that acupuncture is not medicine. If it were,then there would be acupuncturists fighting to do away with needles altogether.
I presume there are three million year old treatises describing the use of sharpened stones for therapeutic purposes, and diagrams of the acupuncture points.
Mephistopheles: "Their conclusion that better quality control and manufacturing processes are reasonable given their focus and backgrounds."
Actually, no, their conclusions are not reasonable.
If you look at the paper, you'll see that there's no attempt to judge their results against any kind of objective standard. This is exactly the same as the chicken nugget study: magnify something really big and say "Oh my gosh, it looks really yucky!"
My immediate thought was, what would a conventional 25 Ga hypodermic needle would look like at 5000x mag? Google led me here, where you can see that even at 500x, it's a lot more blunt than any of these. Or you can simply note the 2 micron scale bar in these pics. Even a blunt needle like H5 in Figure 1 looks like the tip is only 10-15 microns across. That's about the size of a single human cell. And most of the tips are much sharper.
As for the debris on the needles, same issue. There's no objective attempt to evaluate whether that's bad or not. Just, "Ooh, gross!" Once again, what if they'd also imaged 10 sterile insulin needles for comparison? I bet they'd have seen similar amounts of debris. (Which could easily have been introduced during their own handling.)
It's amusingly ironic. If they'd bothered to apply actual scientific principles, they could have claimed that the needles were really good - much sharper than a conventional hypodermic. (Not that it matters, since acupuncture is bogus.)
Even for tooth-fairy science, this is terrible.
I'd be careful about reading three million year old documents, myself. They have a distressing tendency to attract things that dwell in angles, or invisible demons that eat the reader. The mildest ones merely cause madness.
Hmm, that may explain something about acupuncturists.
qetzal - you're correct, the lack of an objective standard in the paper is troubling. I had assumed that they had some expertise in the industrial processes of making thin pointy things, but this may not be valid.
LW - One must be careful, lest one call up The Acupuncturist of the Clinic with a Thousand Needles.
I imagine that "sharpened stones" were eventually replaced by the more efficacious "pointed sticks".
Ia! Ia! Stab-stickyoumuch! Quack with a thousand jabs!
1. It is fashionable to claim that the fine-gauge needles depicted in pre-industrial Chinese medical writing did not actually exist, but others are free to disagree. If it were true that acupuncture were less than 100 years old, it would not follow that it was ineffective, any more than is the case for many allopathic practices of more recent vintage.
2. You can say that acupuncture should never be done to you, but you can't impose that value judgement upon those of us who do not agree that a modality that can beat a pharma drug in a head-to-head trial has zero value.
3. With regard to those trials that show acupuncture and "sham" acupuncture to be equivalent - not all of them by any means - you also do not get to decree that acupuncture must work by puncturing the skin or not work at all. Further, had the sacred Toothpick study actually reported that acupuncture was better than the Toothpick, you would have proclaimed that study to be worthless because it was not double-blinded. You do not get to decree that a study's value depends entirely upon whether you like the results.
Jane—
Re. your:
1) You do realize that any time anyone uses the word "allopathic" anybody with two brain cells to rub together immediately stops reading, right?
2) In what the hell trial did acupuncture beat a "pharma drug" (another cue to stop reading)?
3) Projection much?
Jane--
Even the Chinese don't believe that acupuncture works. My wife is from China and they see it as something akin to chiropractic doctors here. Nobody uses it for anything serious. They see a real doctor.
@jane
Could you specify which medical writing you are reffering to? As a Chinese history nerd I'd love to check it up. Just title and/or author will be enough, I'll google/baidu the rest.
puppygod, what's wrong with you? "Others are free to disagree." It's a matter of intellectual freedom. What kind of fascist are you, expecting them to have evidence in order to disagree.
Yeah, that's true. These sharpened stones were sometimes nicknamed "arrowheads".
One of the most sought-after therapeutic effects was to convince the patient to go look somewhere else for food or women.
It was very efficient on saber-tooth tigers, which, as we all know, are too dumb to experience placebo effects, so it must really be working.
(note to LW: I actually think your hypothesis is much cooler)
@ Denise in #15
I would put my money on a re-purposed Thagamizer.
(In the one place I expect many to get the reference...)
@puppygod:
I looked at some of the citations in the Xie et al paper, which ultimately led me to this paper by Kan-Wen Ma at University College London. It purports to describe evidence of acupuncture in China dating back at least 2500-3000 years. I don't have the background to evaluate its reliability, but as a Chinese history nerd, perhaps you will.
Of course, I agree that acupuncture's true age is irrelevant to whether or not it works.
I'm shocked those chuckleheads didn't just go to the next step and suggest solving the nonexistant problem with nanomachining -- "needles so fine you can't even feel them go in!" (wink wink, nudge nudge, say no MORE!) :)
Psychic energy needles! Totally safe! Boosts the immune system, restores energy balance!
Betcha someone's already offering this!
jane,
It is fashionable in these parts to insist on evidence to support unconventional claims. It was realizing that the ancient Chinese needles described and in some cases found were much more likely used as lancets that convinced me that the whole 'ancient acupuncture' claim was bogus. The descriptions in ancient texts are entirely consistent with the same bloodletting and lancing techniques being used in Europe at the same time.
The Treatise of the Yellow Emperor even has a table that has pictures and describes the uses of the nine types of needles in use, which include a needle with a "triangular sharp head; used to cause bleeding", and a needle with "cutting edges on both sides like a sword; used to make incisions to drain pus". A "filiform needle: the body is thin as hair" which is "the most extensively used one" is also described, but sadly this is the only needle for which no use is described in this paper (PDF) that describes them. Perhaps there's a translation of the Yellow Emperor somewhere that explains precisely what the filiform needles were used for. You will have a hard time convincing me that they were used for anything very different to those being used by Roman surgeons in Europe a few centuries later (these are replicas used by re-enactors, I believe). I would be very interested to see anything that contradicts this, as I have searched and failed to uncover anything convincing. If you look at the evidence through an, "acupuncture with fine needles" filter, and also through a, "medieval bloodletting and abscess lancing" filter, I think Occam's Razor favors the latter.
This follows logically of course, yet is extremely disingenuous. It is the claim that acupuncture is a carefully honed modality based on thousands of years of carefully recorded experiments that is falsified by its lack of vintage. The claims of efficacy are put to rest by numerous clinical trials.
Is this cardiac arrhythmias again? I thought this was put to rest after our last discussion of those studies. Anyway, no one is suggesting that people should be stopped from having acupuncture, but I believe I have a right to inform people that the treatment they are paying for has no rational basis.
Neither do you get to move the goalposts by claiming that acupuncture can work without puncturing the skin. If the skin isn't punctured it isn't acupuncture - the clue is in the word.
So now you are complaining about an entirely fabricated response to a fictional result of the study? You do not get to invent the results of clinical trials and complain about imaginary responses to those invented results. If there was good evidence that acupuncture worked I would be all in favor of more research to find out how. All I see are barely statistically significant results, mostly on self-limiting diseases or those that have a large subjective component, or results looking at conditions for which conventional medicine has little to offer. Often they compare one more or less useless treatment with another, finding that acupuncture is better than an ineffective conventional treatment (antidepressants for fibromyalgia or somesuch). I think it's finding signals in noise; I don't see anything clinically useful in there.
@ jane -
"Fashionable"? We're not talking about what's showing up on the runway at Milan this season dahling, we're talking about evidence: who got it and who don't.
The only reason we are even discussing the history of acupuncture and whether the modality we're calling acupuncture actually goes back 100 years, 3000 years, or 9 umptillion years is because your side keeps arguing that acupuncture as it's practiced now has a long history and that said long history somehow indicates the modality has actual efficacy. Your extraordinary claim = your responsibility to support all components of your claim with evidence. "Others are free to disagree" - well, whoop-de-poop, summon the reporters for the freaking press conference. People are "free to disagree" that we landed on the Moon, it doesn't mean they're anything but idiots.
Oh gosh! You're so completely right! It is so, so bad of us science-based folks to make a big deal of how old acupuncture is - Oh, that's right, it wasn't us; it was your folks who did that. And did so in a spectacularly idiotic fashion, or do you want to try and tell us what evidence survives from the Stone Age to tell us that sharpened stones were ever carefully pressed to the meridians of our prehistoric ancestors in an attempt to alleviate medical conditions?
I'm curious; did you actually sit down with a piece of paper and say "Hmmm, here is the linchpin of my argument; I don't want it subjected to too much scrutiny, so let me see if I can complicate my phrasing so that people have to unravel several layers to get to the very important assertion I'm making without backing it up"? I'd love to see in just how many studies acupuncture outperformed a pharmaceutical treatment and placebo, and whether those studies were ever replicated.
Let me get this straight. Are you actually claiming that puncture is not a necessary component of acupuncture??
But leave that aside, because it's a side-issue. The main issue is that once again, you are trying to reverse the burden of proof. If you want to argue that acupuncture, or acupressure, or acupokewithsomethingpointyure, or any such variant, has medical benefits, you better pony up your evidence that it's so, not whine that science-based medicine was somehow profoundly unfair or misguided, to subject those varieties of acupuncture which puncture to testing.
And let me guess, you think that's unfair? You think that's not the way things should be, because it means acupuncture has an uphill battle to prove its value?
Guess what, it is the way things should be. If someone hands you what purports to be a $1000 bill, and you had to decide whether to accept it as genuine or counterfeit, would you accept it if they told you "you can judge it on whether the color's right OR whether the picture on the bill is of the correct President, but not both"? Like hell you would. You'd tell them that if the color's wrong or the picture's wrong or the paper's wrong that it isn't real currency and you ain't taking it.
The same is true with scientific research. There is none of this BS about "it's so unfair that you might look at multiple sources by which error might have been introduced into the experiment." Every source of possible error that was not eliminated from the experiment is a valid reason to look on the results with doubt. This is not a freaking sporting event, where asymmetry between the sides means someone's running the game wrong. This is science, where we are trying to wrest certainty-beyond-a-reasonable-doubt from the maw of a chaotic, confusing universe filtered through our own limited and flawed cognitive systems. There should be only one reason a hypothesis emerges from that system with a verdict of "confirmed beyond reasonable doubt", and that is because we managed to eliminate all that doubt.
You on the other hand seem to think that as soon as we have eliminated some doubt, the burden of proof has suddenly magically changed and now acupuncture is proven to have at least SOME validity. Doesn't work that way.
I don't even know whether you believe that straw man yourself, but either way it's BS. No one is decreeing that the study's value either depends or SHOULD depend on whether we like the results. But anyone who used a LITTLE FREAKING BRAINPOWER should certainly be able to see that a study whose results say "oh, hey, we've found another thing which doesn't actually have any real health benefits" doesn't need to be scrutinized as hard as a study that says "hey, guess what? we've found a wonderful, awesome new medical modality that produces awesome results, even though there's no apparent mechanism by which it could do so!"
Calamity @17
You might want to the springs on the post checked after you put so much loaded language into it.
Has anyone ever determined how wide the acupuncture meridians are? How precisely do the needles have to be placed to work? How much variation is there in meridian location between individuals?
Let's just stop pretending that medical science is unbiased. That funding has no outcome on the results of trials. Most of the comments here trashing validity of acupuncture seem to come from the stance that in contrast to nearly every other therapy you can name is not based on balanced unbiased science. Whether therapy x valid or not is immaterial until such times as that the various cherry picking of results, blatant ignoring of the rates of iatrogenic illness, various spectacular failures, (Thalidimide anyone?). The standard adoption of eminence over evidence http://www.cochrane.org/news/blog/eminence-vs-evidence in standard medicine either stop or are at least taken into account when comparing with so called "quack therapies" can we really claim to have a real comparison.
You guys are so far up your own ass you'll never stop the consider the possibility of a science you weren't taught at school. "My tyre pressure light came on", was the highlight of that whole ramble. I was driving along the other day and my small minded twerp with an axe to grind light came on, you must have been nearby.
Well, there's your problem; you need one of these. (The axles and springs are readily modified.)
You can gear them as daily drivers, plus you wouldn't have to worry about sluggish handling if you didn't want to, since they didn't come with power steering in the first place. It doesn't matter, as the frame is solid pig-iron and will scoff at most collisions.
Upgrades from the stock lap belts are available, anyway. You may have to get out to lock the hubs once in a while.
Pretty wide, judging by diagnosis through palpation (e.g., here and here).
#31
Give me a Subaru WRX-STI and to hell traction control, I just need a handbrake.
Alain
^ From the first reference: "During acupuncture treatments, acupuncturists use these landmarks and measurements to determine the location of each point within approximately 5 mm. Precise point location within this range is achieved by palpation, during which the acupuncturist searches for a slight depression or yielding of the tissues to light pressure."
(The second one fell out of a cursory search for Cheng 1987.)
@antaeus, krebiozen et all.
Is it any wonder the woopushers only ever indulge in hit and run comments here, when their logic gets so comprehensively mashed on every occasion?
@whataroll: Wow. I was tempted to play "count the alt-med trope" game with your comment, so riddled with nonsense it is. You prattle about "eminence versus evidence," but you appear to have neither. Got any evidence?
The roads around here would easily eat it. Nothing short of a tank is likely to survive.
Of course, I do not live in Australia. Got any evidence rather than complaints about my admittedly occasionally self-indulgent writing style? No? I didn't think so.
It's hilarious to see the indignation of posters like Justin when someone thoroughly gores their sacred cows.
Driving on potholed roads, you really need to learn to Judge Craters.
Narad,
Years ago I bought an electroacupuncture gadget, mainly for the cranial electrostimulation attachment that came with it. It detected acupuncture points using skin resistance, letting out a squawk when the probe was over one, and you then pressed a button to deliver an small electric current to the point. Using it experimentally, I found there were points where there are supposed to be, but there are also points in thousands of other places. I would say they were a millimeter or two in diameter, thought that presumably depended on the settings of the gadget i.e. how low the skin resistance had to be before it triggered.
BTW I treated myself, friends and family for a number of minor ailments, but I never found it helped anything really.. A slightly painful treatment makes a good distraction, but that was about the extent of its usefulness.
That would be "whatatroll", with two "t"s.
I think the altmed trope count can be reduced primarily to the usual one of "Modern medicine isn't perfect, so anything goes".
Troll indeed.
whatatroll,
I wasn't aware that anyone was pretending any such thing. One of my problems with acupuncture trials is that the only people who seem to be able to get positive results are those who are already True Believers and are highly motivated to prove it works.
Compare acupuncture for pain, say, with an opiate like morphine or methadone. Are you claiming that the clear superiority of opiates over acupuncture is down to bias of some sort? Which therapies in common use are not based on unbiased science? Studies I have read suggest that upwards of 80% of conventional medical interventions are based on some sort of compelling evidence.
Conventional medical science doesn't, or shouldn't, cherry pick, it uses systematic reviews and metaanalyses with very carefully chosen criteria for assessing the quality of clinical trials. As far as I can see it is the CAM crowd who cherry pick the few positive trials for acupuncture and ignore their poor quality, and ignore any negative trials.
No one is ignoring iatrogenic illnesses. The hospitals I have worked in are constantly looking for ways to improve performance, prevent errors in prescribing, avoid unnecessary polypharmacy etc.. If you are referring to the grossly exaggerated figures touted by Gary Null and others, of course they are ignored, since they are both inaccurate and decades old.
What has a drug taken off the market more than half a century ago to do with anything happening today? Don't you think medical science has learned anything in that time?
More to the point, what has any of this to do with whether acupuncture is effective or not?
Did you actually read the Cochrane article by Alan Cassels (who, in the past, our host has criticized as being "clueless" about vaccines) you linked to? It is championing systematic reviews and metaanalyses, just as science and evidence based medicine should! Look at the Cochrane reviews of acupuncture, which are without exception unimpressive, and then tell me that they support its efficacy.
Amusingly the first example given, of statins for primary prevention of cardiovascular disease, is badly out of date. The systematic review linked to was last assessed as being up to date in 2007. The latest Cochrane review of statins for primary prevention of cardiovascular disease is here and concludes:
It looks like the evidence supports statins for primary prevention of CVDs after all.
The English major in me counted; the only grammatically correct sentence in whatatroll's diatribe is the first. In some cases, one can deduce what he's trying to argue; in others, one is left having to guess, since he's gone into so much detail on the subject he forgot to include a verb phrase.
Nevertheless, I feel safe in guessing that the GENERAL gist is:
1) You can't go criticizing alternative therapies and asking if they even work at all, until modern medicine not only works, but does so absolutely without flaws or mistakes (and has for half-a-century, apparently, judging from the reference to thalidomide.)
2) Modern medicine has flaws and mistakes.
3) Therefore, we can't say anything about alternative therapies such as acupuncture.
The problem is that premise 1 is, to no one's surprise, Wookiee doots. Whether it's mainstream medicine or alternative, any time someone is going to be subjected to it, we get to ask "where is the evidence that it is safe and effective?" Should we do what we can to improve modern medicine? Yes! Is it likely that there's still a ways to go in that goal? Yes! Should alternative medicine, also known as "some stuff someone came up with", get a pass until such time as mainstream medicine is perfect? Obviously, no.
Just for the record, the WHO does not recommend medical modalities which have been demonstrated to be no more effective than placebo. The WHO does not recommend the use of acupuncture.
Dear drive by poo flinger,
It's Albuquerque, you idiot. And yes, you shoulda made a left there . . .
Thanks, Pareidolius
I skimmed over the location and didn't notice that.
Just an anecdote:
My wife who had a heart attack two years ago is taking a statin. Her doctor was happy to tell us her cholesterol numbers have improved!
whatatroll: "Thalidimide anyone?"
Yes, do tell us about thalidomide. Explain how it progressed through the approval system at the FDA in the United States. Tell us why the manufacturer tried to bypass one particular reviewer who was asking for more data.
Oh, wait. Do you even know about that little bit?
By the way, Krebiozen, thalidomide is approved in the USA for some very specific things like Hanson's disease and certain cancers. The use by women of child bearing age is restricted.
I second that, Chris.
One of my big questions for CAM advocates is, "what technique, method, treatment, etc. has been eliminated from standard practice because it has been show to be ineffective or too risky?"
The comparison is not infrequently drawn. They don't care about the existence of a road.
True that, not to mention that the roads around here look as though the army has been using them as target practice ranges for tanks.
A10's do more damage.
Pareidolius, thank you for reminding me of one of my late father's favorite jokes.
Orac, you could always move to Alaska, which spends more per capita on bridges and road repairs, than any other state. :-)
http://www.detroitnews.com/article/20140213/METRO05/302130103
Chris,
It's a very promising drug for a number of conditions. My sister-in-law, in the UK, is (or was, I'll ask my brother) on thalidomide for mutiple myeloma, and she has been stable for years now.
BTW, I may have mentioned here before that my mother told me she had thalidomide (a free sample from a drug company rep for my GP dad) on her bedside table throughout her pregnancy with me, but never took it.
@ Shay #54
Oh, I'd think an M1A1 going full-tilt on a paved road would leave quite a rooster tail of asphalt. To say nothing of the "skid marks" it would leave if the driver suddenly jammed on the brakes. :)
'...the beaks of birds' eh? This is just begging for a Sokal-style takedown:
'Our study found that patients exposed to pecks from live canaries experienced greater relief from symptoms than a control group who were stimulated at random locations by "pecks" from a carefully-crafted plastic simulation of a canary beak (N = 26, p < .005).
'We conclude that 1) Natural bird pecks are more efficacious than artificial bird pecks, and that 2) Canaries likely have an innate intuitive healing-sense that guides them in their placement of pecks on the patients' bodies.
'This study was preliminary, and we call for additional research funding of 2 to 3 million Dollars. We are presently seeking an appropriate source of grant money; interested investors may contact us at Birdbrains@altmed.woo.'
Right!
Kind of makes you look at "The Birds" in a whole new light.
While #52 was meant to refer to the offroad capabilities of the Scout, as it happens, I have a relative who took it into his head to show off his new toy, a surplus M3A1 Stuart,* in a local parade. I forget what the amount of the settlement for road repair was.
* If I'm correct about the current location of it and the "matching" halftrack. I would've guessed M3A3, maybe M24, from what I little visual recollection I have of it.
Narad, Scottynuke -- About tanks: the Chelyabinsk meteor impact almost exactly a year ago alerted many of us to the amazing world of Russian dashboard-camera videos -- this is actually tamer than many!
"It’s clear from the very beginning that the investigators are True Believers."
Yes that is always clear. In the case of the many, many, trials which have now been carried out on acupuncture that is abundantly, transparently clear.
Those carrying out these trials are nearly always acupuncture practitioners. Poor quality trials may give the desired result very easily. Good quality trials, not.
What gives the game away is that when a trial gives the wrong result - showing acupuncture to be no better than placebo - the authors always find a way to say that acupuncture is nonetheless a worthwhile treatment. Or, at the very least, that more trials are still needed.
Hilarious study. Besides all the usual silliness and the Tooth Fairy pseudoscience, they appear to claim a history of acupuncture much longer than the usual "thousands of years" trope.
"The use of acupuncture can perhaps be traced as far back as the Stone Age (around 3 million years ago)"
Is this an "Appeal to Mega- history" ?
Palindrom: Your Judge Crater pun wins the internets trophy for this week.
Somewhat on topic for pseudoscience or whatnot: A Tennessee snake handling preacher who was featured in a National Geographic documentary was bitten by a snake, went home, and died. He did not seek medical attention. I will avoid typing bad jokes about snake venom being natural and organic.
Kreb and others: Have any of you heard of the practice of metering for negative ions in the air and elsewhere? Google University shows a large number of devices that are for sale, which basically seem to detect the input to a field effect transistor (ie: depends on input voltage rather than input current) and this is supposed to be something of importance. There are also bracelets and whatnot that are supposed to provide some miraculous benefit by generating negative ions that somehow enfield the entire human. Not very good science fiction, but they are for sale.
I ask because an acquaintance wanted to convince me that some natural substance emitted negative ions, so he put the stuff in a plastic bag and held the negative ion detector against the plastic. (chemists and ham radio operators can have a hearty laugh at this point). The meter showed lots of ions. So my question is this -- is the miraculous creation of negative ions by bracelets or other unconvincing technologies some popular form of woo? Also note that at least one web site claims that the ions are formed as the result of near-infrared striking the bracelet. Strikes me as unlikely, to put the most diplomatic spin on things. Even I have a problem with something having a wave length of a yard knocking electrons and protons off of molecules.
Yes, ionic woo most definitely exists, Bob G, but seldom has much relationship to actual chemistry or physics. The field measuring devices work, of course -- they're mostly built for scientific and engineering applications. But they don't do what the marks think. I think at least some of the promoters are actually con artists, and know perfectly well that this is all BS.
There are devices to ionize your drinking water, which also filter out all contaminants, a situation which amuses me tremendously given how this all works. I find myself wondering if this has in any way impacted sales of deionized water in grocery stores. ;-) (Deionized water isn't sold for woo properties, but simply because it's cheaper than distilled water and can be made onsite. I buy it for my iron, because my municipal water is pretty hard with calcium. Lotta limestone here.) I would love to find a person buying deionized water to put into their home "ionizer" unit. :-D
"There are devices to ionize your drinking water, which also filter out all contaminants,"
Hmm. Seawater is contaminated drinking water. If it separates out all the contaminants, such as gold etc., they could become very wealthy (and make a mountain of sea salt). Instead they earn a tiny fraction of that by selling these devices.
Gosh, in astrophysics, at least, the word "ionize" when applied to matter in bulk means "strip away one or more electrons from most of the atoms", as in 'the re-ionization of the intergalactic medium".
Ionizing a glass of water would take a helluva lot of energy - something like 10 eV per molecule. There are quite a few molecules in a glass of water.
Well, sometimes.
Thanks people. Interesting discussion. I'm wondering whether an ordinary plastic storage bag would pick up a little negative charge along the outer surface, enough to be detected by an electric field detector. I'm assuming that the devices being sold as negative ion detectors are just the equivalent of a fairly sensitive voltmeter, and don't really distinguish between the charge you would pick up walking over a wool rug vs. ions in the air itself.
They will, however, detect your wallet being stripped of base metals and maybe even some fiber.
Why are they confused as to what causes the bleeding and bruising anyway? Isn't that just what naturally happens to the body when you're jabbing it with sharp things?
I'm a little pissed off at my alma mater; they're offering the following PhD scholarship:
"PhD position in efficacy of acupuncture on postmenopausal symptoms"
Really?
/shakes head
Some 20 years ago someone gave me a device that was supposed to create a stream of negative ions, cleaning the air and providing unfeasible health benefits. It did seem to do something, if coating everything within a 3-feet radius with a film of dirt counts. I assume it worked through static electricity, as it had little sharp metal spikes that gave off tiny sparks when touched. Health benefits? Nothing noticeable, and I can't think of any plausible reason why there should be. That doesn't stop them from still being sold, of course.
Those water ionizers/alkalizers amuse me too. You can make a cheap version by taking two containers of water, putting an electrode in each, and connecting them with a piece of wet paper (commercial models use a semi-permeable membrane of some sort), with a few volts DC across the electrodes.
When used on water that contains any common salt, I believe you will end up with a dilute sodium hydroxide (lye) solution in one container, and dilute sodium hypochlorite (bleach) in the other, i.e. NaCl + H2O -> NaOH + NaClO. The hypochlorite is a miracle cleaning product, and you can drink the dilute lye, naturally. For some reason the Japanese are particularly enamored of this variety of woo.
BTW, I can't get that equation to balance, though that might be due to caffeine deficiency - I was interested in this stuff a few years ago and my memory has faded. It might be sodium chlorite that the water alkalizers produce, along with random products of other dissolved salts too, of course, none of which are likely to be particularly healthy to ingest.
rs -- devices which remove all (well, nearly all) contaminants from water are actually rather common and can be found in any supermarket. The reason nobody is getting fabulously rich selling gold from seawater is purely a scale problem. ;-) Also, using a deionizing system to purify seawater is gonna bankrupt you in filter replacements. For desalination, you're better off with distillation.
That said, people *are* making money selling sea salt, but they are using a much more practical method: they're just closing seawater off in a brine pool and letting the water evaporate away in the sunlight. This is the origin of "solar salt".
Bob G:
Absolutely! I work in embedded computing, which means our labs have lots of equipment that is very sensitive to electrostatic discharge until it gets properly buttoned up in the finished box. If you want to give fits to the quality control people, leave a sandwich bag on one of the ESD (Electro-Static Discharge) mats. Plastic is a *major* offender for charge generation. The worst offender of all is probably scotch tape; the action of pulling the plastic film away from the roll is just about perfect for triboelectric charging. There are special baggies we can use that don't do that, and special tapes as well; they have special materials embedded in them to resist charging.
But your usual voltmeter won't pick that up. You need a field meter to pick it up. And people who have bought into EM woo often find themselves buying those and then being AMAZED at how many invisible evil fields there are all around them!
Oh, we also use ionizers in our manufacturing plant, in a couple of extra-sensitive areas. These are not for our health. They are for the *product's* health. A stead flow of ions helps gradually dissipate charge that has built up in spite of our precautions, so that there isn't anything much to discharge later. I still laugh at the lessemf website, which sells the sorts of things used for ESD protection and RF shielding in industry to the general public for protection from the evil electrostatic fields and EM fields and R/F and whatnot. And I still love their project ideas for sewing garments from their fabrics. Many look ridiculous, and many more would be totally ineffective. The Faraday Hat is, for my money, the funniest one on there, because it a) looks hilariously stupid, and b) won't provide effective faraday protection anyway since it doesn't go all the way around. It apparently shields the seamstress's spine from R/F while she works in the garden....
One addendum: I think it's interesting the woos have caught on to *some* ESD materials, but not all. I will laugh the day they start packing their lunches in pink poly bags placed inside black foamcore conductive boxes.
Thanks all. You caused me to remember the whole bit about using the grounded wrist strap when handling various semiconductor items, and how components come wrapped in anti-static bags. Unfortunately, some of the woo comes up from time to time in the political context. For example, we have a motion to hear at the neighborhood council about a cell phone tower (I guess that would be mobile phone tower to the Brits) that is next to somebody's house. I'm willing to stipulate that those things can be noisy, but I'm not going to agree with my colleagues that the apparatus creates a health hazard. A few months ago we heard from some people who opposed the concept of the city of L.A. putting in wifi, because of emf sensitivities. One of my friends who is a longtime ham radio operator was quite annoyed with the whole performance and gave an extensive criticism. The subject never came up again, so it would appear that most people recognize this kind of thing as tinfoil hat territory. I think the alkaline water fad is of an equal level of ignorance, but seems to be spread among people who are otherwise sane.
On the subject of placebos, I see Horizon this evening on UK BBC TV is:
No doubt it will appear on US TV at some point, and on YouTube if not. Judging by the blurb I suspect I may be having a heated conversation with the television later on.
@ Bob G
I think in Israel some people died, because someone tried to blow up an antennae, because it was supposed to cause cancer.
http://www.haaretz.com/news/national/1.574628
"rs — devices which remove all (well, nearly all) contaminants from water are actually rather common and can be found in any supermarket. The reason nobody is getting fabulously rich selling gold from seawater is purely a scale problem. ;-) Also, using a deionizing system to purify seawater is gonna bankrupt you in filter replacements. For desalination, you’re better off with distillation."
Callie, you are of course correct. I've even used such devices in the past, but then stopped when I realized that tap water itself was cleaner than what came out of the filter. These filters typically involve moving a select group of particular matter from one mass (the water) to another (the carbon, e.g.). Those impurities are not economically accessible from either mass.
But the ionizer? There is no second mass to "accept" the impurities. Where are they? They must be in the device, somewhere, if they're being separated out. That they aren't there is indicative of the device's efficacy.
There are more expensive water filters widely available that clean water by removing particulate matter down to micron size. But they don't remove impurities in solution, and the filter has to be periodically cleaned because all those impurities clog the filter. That is, they show evidence of working.
Speaking of which, I was catching up on Retraction Watch just now, and this item popped out (regarding an otherwise apparently minor retraction of two Blood Work images).
Only $875 for what looks an awful lot like a Ghostbusters-modded analog VOM.
rs -- depends on the tap and the filter, though I've never seen a filter that leaves the water *dirtier* unless you've really let it get nasty with bacteria. Home filtration systems are rarely to the standards of a deionizing system (though if one has more money than sense, one can get one that is), but the ones in grocery stores usually are. My chem lab in college had a high-grade system mounted on the roof to provide deionized water to certain taps in the labs for use in our experiments. The tap water there . . . well, it was actually visibly orange sometimes. Ew. But tasty enough if combined with Tang.
"Water ionizing devices" are general complete bunk. One that purports to also be a filter is absurd; that would be claiming to both add and remove impurities, in my opinion. Although, given that in chemistry terms, saltwater is considered ionic (in the sense that there are ions in it), I would argue it counts as "ionized" to mix Tang into the drink. :-D
Now, the ionizers we have in our manufacturing lab, which I alluded to earlier, are a completely different story. And rather expensive. They don't filter anything (although you can get ones that do, for use in clean rooms). They just ionize air and push it out over the product. More than a few inches away, they're not very useful, as the ions of course merely dissipate into the air.
@Darwy 72
A recent Cochran Review of acupuncture for menopausal hot flashes (Dodin 2013) found some evidence that acupuncture is beneficial compared with no treatment, but no more so than sham acupuncture. They found the evidence to be of poor quality, lacking adequate controls and data on adverse effects.
There is evidence of a high long term placebo response rate (~ 60%) for reduction in hot flashes compared to hormone treatment (93%) - no surprise as hot flashes are expected to reduce with time.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2783540/
I therefore predict that acupuncture, should a high quality trial be carried out, will conform to what is already known. Will not be nearly as effective as hormone treatment, but likely safer. Will be no more effective than sham or other placebos but like them, will be better than no treatment at all.
Are placebos ethical? That is the question.
Callie - "rs — depends on the tap and the filter, though I’ve never seen a filter that leaves the water *dirtier* unless you’ve really let it get nasty with bacteria."
Yes, exactly. The thing is that the tap water here is very good, if a touch hard, and there is the lack of certainty in the field with consumer-grade filters to know when they're exhausted or fouled. Strict adherence to the replacement schedule is required but often ignored or poorly practiced.
Leigh Jackson: Your link leads to a NCCAM-sponsored study of Black Cohosh and Red Clover for post menopausal hot flashes...not acupuncture.
lilady,
The evidence for acupuncture for hot flashes is not of high standard according to the recent Cochrane Review. I linked to the study of botanicals as being a high quality study showing a high placebo response for red clover, comparable to the response found in straight HT v placebo trials. This is an interesting study because red clover reduced anxiety significantly compared with placebo.
Which shows that alternative treatments can, of course, be found to be of benefit in high quality studies.
I predict acupuncture for hot flashes, in a high quality study, will fare no better than sham. What would br good is if non-acupuncturists started to research acupuncture. We might then have some sensible summaries, instead of assertions that though no better than placebo, acupuncture is still warranted as a treatment.
lilady
Importantly, in the case of red clover, there is a plausible biochemical mechanism for the reduction of anxiety. This is a fundamental problem for acupuncture.
Krebiozen 73 & 74
There is hydrogen liberated in that process, which is probably what you were overlooking in trying to get it to balance.
Electrolysis of salt is very widely used as an alternative to bottled chlorine for swimming pools. It is much safer for pool staff, barring the consequences of bad luck from spilling salt, or course.
There are also hand-cranked and solar powered salt electrolysis devices available for treatment of drinking water in emergency situations or remote locations. UNICEF is involved with one that is AC line powered.
http://unicefinnovation.org/projects/automatic-chlorine-generator
This is an interesting study because red clover reduced anxiety significantly compared with placebo.
Might explain all those happy, calm cows out there.
Acupuncture studies done on humans have been marred by the placebo effect. However, mice do NOT have a "placebo effect"
In the article below (Disclaimer: I am acknowledged in the article), electroacupuncture does alleviate sepsis in mice:
http://www.nature.com/nm/journal/vaop/ncurrent/abs/nm.3479.html
The expectations of human observers, however, do fall under the placebo umbrella.
And TENS is not acupuncture.
Thank you for your feedback, Scottynuke.
Just two comments:
1) No voltage = no effect, and thus, it is not as you say 'classical' acupuncture
2) When electrically stimulated in a non-acupoint, there is no effect.
Sincerely
Patrick Morcillo, Ph.D.
Actually, they do. For example, see J Psychopharmacol. 2010 Oct;24(10):1561-7. doi: 10.1177/0269881109104848. Epub 2009 Apr 24.
It is amazing how often people remember that the placebo effect works on human subjects, but forget that it also applies to the human observer. Why assume the person observing the mice is impartial and unbiased? Humans are biased almost by default, no matter how hard we try not to be. That's the whole point of placebos and double-blinds; to correct for our biases.