Acupuncture Is Theatrical Placebo

Anesthesia & Analgesia Magazine:

Curiously, given that its alleged principles are as bizarre as those on any other sort of prescientific medicine, acupuncture seemed to gain somewhat more plausibility than other forms of alternative medicine. As a result, more research has been done on acupuncture than on just about any other fringe practice.

The outcome of this research, we propose, is that the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance. It seems that acupuncture is little or no more than a theatrical placebo. The evidence for this conclusion will now be discussed. [...]

We found evidence that these responses seem to follow a common trend of early rapid improvement in symptoms that slows down and reaches a plateau 6 months after the start of treatment, although the size of response varied widely. We found a similar pattern of improvement in symptoms following any treatment, regardless of whether it was index, active comparator, usual care, or placebo treatment. [...]

Since it has proved impossible to find consistent evidence after more than 3000 trials, it is time to give up. It seems very unlikely that the money that it would cost to do another 3000 trials would be well-spent.

I had acupuncture years ago as treatment for RSI, and my experience was exactly this: early rapid improvement in symptoms that slows down and reaches a plateau. Also, it involved electroacupuncture, which they characterize as "essentially transdermal electrical nerve stimulation masquerading as acupuncture."

Pull the wool over your own eyes!

Also, tuttles.

About a year ago the dedicated folks at the Marine Stranding and Rescue Center in Virginia Beach, VA brought two sea turtles in to a clinic where I was working for evaluation and possible acupuncture treatments. Both turtles had problems with mobility.

Amazingly, we found references to a few acupuncture points in turtles, so myself and a second acupuncture trained veterinarian began with these. I coupled these treatments with chiropractic adjustments on their necks. [...] I finally added some Chinese herbals into his protocol, and we began to see the improvements that we were looking for.

Previously, previously, previously.

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32 Responses:

  1. Jake Nelson says:

    I've spent far too many hours trying to explain to certain people that "placebo" doesn't mean "ineffective". Sadly, psychosomatic reactions (both good and bad) are so poorly explored- too many otherwise-scientific-minded people dismiss it as religious woo, and too much quackery has been let through unexamined...

    I've read several things that say in comparative tests, acupressure actually works better than acupuncture (TENS on acupuncture points was, as you might expect, better still...)

    • nooj says:

      If a treatment is "no better than placebo," it means the treatment is ineffective.

      Otherwise, consider this: In randomized trials, prayer is no better than placebo. The placebo effect is real. Therefore, God exists.

      • Rich says:

        It doesn't mean it's ineffective. It does mean that you could do some other placebo trick which is safer (as in, doesn't involve sticking needles into you) such as eating a sugar tablet.

        The placebo effect is a real way to diminish pain and is well-documented. This has nothing to do with the existence of god.

        • Ben says:

          It does mean that you could do some other placebo trick which is safer (as in, doesn't involve sticking needles into you) such as eating a sugar tablet.

          I don't know about that. The whole point of a psychosomatic effect is that the subject has to believe something useful has been done; it's likely that something expensive and/or slightly frightening and/or backed up by some manner of user-appropriate justification is going to be more effective in that regard than an anonymous pill handed out by a doctor who obviously doesn't believe it will do anything.

      • Jake Nelson says:

        Very wrong. The placebo effect is huge. A sugar pill placebo produces far better results in clinical trials than no treatment. The reason "demonstrably better than placebo, outside the margin of error" is the standard that determines whether a drug is worthwhile or not is because if it's not better than a sugar pill, why not just give them a sugar pill?

        When it comes to things other than pills, there's an issue with determining the correct placebo- a sugar pill vs. massage is apples-and-oranges.

        Also, prayer is not "no better than placebo", it's far worse than placebo. If the patient is prayed for by people but isn't told, effect = 0. If the patient is prayed for by people and told so, effect = x. If they aren't prayed for, but told they are, effect also = x. If they're given a sugar pill and told it's medicine, effect = y. The values of x and y vary greatly depending on the person, largely related to their levels of belief in prayer and medicine respectively, but in very nearly all cases, both x and y are positive, but x (prayer) is less than y (sugar pill).

        • Douglas Knight says:

          Why not prescribe placebos? Because deceiving patients about placebos is malpractice in the US. It used to be a gray area, but a 2006 AMA report condemning it probably sets the law.

          The law is probably different in other countries. Surveys suggest that even before the change placebos were more popular in other countries.

      • nooj says:

        You people, jesus. The prayer thing was a troll. I know what the placebo effect is and how it works.

        My point is that you live in a crazy world if you think a costly treatment that has all the positive outcome of a piece of candy is worth being called "effective."

    • phuzz says:

      I read something a few years ago that said that the effect of placebos is increasing over time, found by looking at the results of a bunch of clinical trials and how effective the placebos used were.
      Of course I've forgotten where I read this and have no source for it.

      I know someone who had their appendix removed using acupuncture rather than an anaesthetic. Personally I'd stick with drugs.

        • Douglas Knight says:

          Every example of placebos getting stronger with time in that article is about antidepressants. Most of the rest of the article is, too. But it hints at an alternate explanation: after the effectiveness of prozac, depression was redefined to be a much broader category.

          Differences for other diseases across countries are interesting, though.

          • nooj says:

            Agreed. Every bit of this effect can be explained by the trend of diagnosing as depressed a much broader category of people in 2010 than in 1990.

            When you include more people (ie, people who are "less depressed") treatments become less effective, and "cures" become more common regardless of the intervention.

  2. joe user says:

    "We found a similar pattern of improvement in symptoms following any treatment, regardless of whether it was index, active comparator, usual care, or placebo treatment. "

    Which is to say, while acupuncture does not work, it works equally as well as everything else. In fact, there is little difference between usual standards of care and placebo.

    • Douglas Knight says:

      No, for some problems, like back pain, (sham) acupuncture works much better than everything else.

    • Ben says:

      Similar patterns of improvement, not similar magnitudes of improvement. It shouldn't be a surprise that painkillers have a limit as well.

  3. Ronan Waide says:

    Ben Goldacre's Bad Science covers this and the general theatrical weirdness of placebos pretty well - for example, in some trials a red placebo pill is more effective than a green one, or two are more effective than one. For acupuncture specifically there is some suggestion that doing it with appropriate theatricality makes it a more powerful placebo, but a placebo nonetheless - the study in question, or one of its brethren, used some sort of trick needles which didn't actually penetrate the skin, and the results were indistinguishable from using real needles.

    It won't stop people from using anecdata to "prove" its efficacy, though.

    • jwz says:

      I kinda love the idea that theatricality is medicinal. I hope this means doctors start dressing like magicians. Zatanna will see you now.

      • James C. says:

        Many doctors, like the typical primary care physician, do dress in completely unnecessary lab coats. This of course has its own problems, in particular “white coat syndrome”.

        “I hate going to the doctor. Every time I see one swishing around in that pointy hat and the robe, my heart starts racing. Those wands are scary too.”

        • Jon Konrath says:

          I wanted to, as some kind of hidden-camera bullshit art project, ride the NYC subway all day in either scrubs or a lab coat and see how many people would randomly come up to me and ask me to look at a rash or listen to their cough or beg for a narco script. The main thing stopping me is the chance of catching something is probably high.

          • Pavel Lishin says:

            For what it's worth, I've seen plenty of people ride the subway in scrubs, and never seen anyone come up to them begging them to check out their rash.

          • Not in NY, but in Seattle I've ridden public transit and walked/biked around in lab coats and never had anyone say boo.

            But then again, it is Seattle.

      • Ben says:

        Could also do a study on the efficacy of security theater in reducing apprehension wrt traveling.

    • Ben says:

      used some sort of trick needles which didn't actually penetrate the skin, and the results were indistinguishable from using real needles

      "Oh, but they were obviously just doing acupressure on the relevant points..."

      • Jake Nelson says:

        Traditionalists don't believe in acupressure, it's a very recent innovation by people who question the whole jamming needles into people thing, so even moving the goalposts that far is useful. Acupressure has little risk of injury, acupuncture needles break sometimes (and then there's the places that don't sterilize them properly between uses...).

        Whether the points matter or not is an open question- so far tests with random points vs. traditional ones have had inconclusive results. I find it likely that poking people in some spots is more helpful than poking them in others (cue jokes), but I see no reason to think the traditionalists are poking the right ones.

        • Curious says:

          Actually, acupuncturists don't re-use needles. They use each needle once, then dispose of it.

  4. Steven A. Dunn says:

    The turtle article reports the acupuncture was done through the shell. They wouldn't have pierced it, would they? I hope these idiots weren't hurting those turtles.

    • jwz says:

      "Chiropractic adjustments on the turtles' necks."

      • Ronald Pottol says:

        Well, for a measurable effect, I used to wear out the heels of my shoes very unevenly, and differently on each foot. This had gone on for 20 years of my adult life. I was using Shoe Goo to get reasonable shoe life. After seeing a chiropractor for a while, I realized that my shoes were wearing out evenly and normally. So that is a very real effect, though not a cost effective one (I mean, I think it was useful, but an expensive way to save on shoes).