No, Washington Post, acupuncture still doesn’t work

It’s like playing whack-a-mole. No matter how many times I write a column showing the nonsense of a highly implausible practice, a new article pops up claiming, “Hey, check this out!” It actually works! “

I’m going to try knocking another mole because people can be harmed by bad information, especially when it comes in the form of medical advice.

recently, washington post I published a column with the heading “Is acupuncture effective for chronic pain?” This is what science says. ” (This column was first published in July, post‘s website promoted it just last week. )

Before I give you the answer in the post, please tell me the correct answer. no! It’s not “maybe,” “sometimes,” or “I don’t know.” Acupuncture does not cure anything and carries a risk of harm, especially from infections. More on that below.

I’ve written about this topic many times before (2013, 2012, 2010, etc.). washington post against their acupuncture-promoting pseudoscience (see this column I wrote in 2016). Science-Based Medicine doctors have debunked more acupuncture studies than I can count. They even created a special web page (which I highly recommend) to explain the false claims made by acupuncture proponents.

For those who don’t know, acupuncture is the practice of people called acupuncturists (not doctors) inserting needles into the body to “treat” various conditions. The claim is that these needles can manipulate your life force, the “qi” that flows along lines that appear to be acupuncture points throughout your body.

That’s wrong. Modern biology has taught us a lot about human physiology, but there are no mystical lines flowing through it. Yes, there are nerve fibers, but acupuncturists don’t use them. (If the needle punctures a nerve, it will be very painful.)

Acupuncture and Qi are part of Traditional Chinese Medicine (TCM), a collection of folk beliefs that are largely ineffective and sometimes very harmful. TCM began to grow in popularity in the mid-20th century when Mao Zedong launched his propaganda campaign promoting it. Mao Zedong himself never used TCM, but since his government could not afford the real drug, he led people to believe that cheaper folk medicines were just as good. That wasn’t the case.

But I digress.

Although acupuncturists claim to be able to treat many conditions, they particularly prefer to claim that they can treat chronic pain, for at least some reasons. First, pain is inherently subjective, so the only way to measure whether a treatment is working is to ask the patient. This makes it difficult to study objectively. And second, pain symptoms usually increase and decrease even without treatment. Patients usually seek treatment when their pain is at its worst. In other words, once the pain subsides, the patient begins to trust whatever they were doing at the time. So pain is fertile ground for people selling quack remedies.

So let’s move on to that column. washington post. This column promises to tell you “what the science says,” but it quickly cuts to the heart of the matter and answers, “Yes, that’s right!” First, it puts forward the logically flawed (and unscientific) argument that since the U.S. Medicare system currently covers acupuncture for back pain, it must be effective. There is.

Hmm, where do I start? Well, like it or not, just because Medicare approves a treatment doesn’t mean it’s effective. (Conversely, some effective treatments are approved for Medicare coverage.) So it’s just a logical fallacy. It would be nice if it were true that Medicare was based purely on science, but for years the federal and state governments have been trying to convince acupuncturists (and other dubious treatment providers) of their practices. We have lobbied for the public’s tax dollars to be used to cover this. For a deeper dive into these lobbying efforts, we recommend this long takedown article by Jean Bellamy, which describes acupuncture as a “legalized quack.”

The Post article then discusses the science, relying primarily on a single study, a meta-analysis, published in 2019 by Andrew Vickers. (This column was written by Dr. Trisha Pasricha, who has excellent qualifications, including training at Johns Hopkins University School of Medicine, where I also work.) Unfortunately, having good qualifications does not necessarily mean (This is one of those instances). )

Vickers has published multiple meta-analyses, and if he’s shown anything, it’s how easy it is to sift through the (extensive) acupuncture literature to find studies that prove the points you want to make. The question is whether it is.of post The column claims that Vickers used 39 “high quality” studies, but this is debatable. Much of the research was done in China, where (as science-based medicine physicians David Goksi and Stephen Novella point out) virtually no negative research on acupuncture Never announced.

In my medical school class, I looked closely at one of the Vickers meta-analyses on acupuncture (an earlier one). There, he uses it to explain how bad research can be misreported by the scientists themselves and the media. . I don’t have time to go into detail here, but among other problems, Mr. Vickers doesn’t seem to understand how placebo controls work.

This is what cherry picking means. Mr. Vickers researched hundreds of studies, from which he selected 39. One of his studies, considered to be of high quality, focused on acupuncture for knee arthritis. The study found that both acupuncture and sham acupuncture (placebo arm) had the same small effect on knee pain, with patients who received no treatment reporting more pain than patients who received no treatment at all. Did. The study’s authors (and Vickers) concluded that acupuncture must be effective because it’s better than nothing at all, which is incorrect. mistaken! If it cannot beat a placebo, the treatment will fail.

In drug trials, if you can’t beat the placebo, it’s game over. But in the case of acupuncture, that means “more research is needed,” and the game of whack-a-mole continues.

Oh, and I should add that as far as knee arthritis is concerned, pain relief in both the acupuncture and placebo groups was much less than reported in studies using ibuprofen.

That’s right, ibuprofen is much better than acupuncture. Needless to say, it’s cheap and convenient.

If this wasn’t enough, as physician and blogger Steven Novella pointed out in a recent column, more recent research already contradicts Vickers’ research. Novella wrote, “The quality of the evidence is too low to conclude that acupuncture is effective, as desperately as proponents argue that we can reach that conclusion.” . No, Dr. Pasricha, current science does not say that acupuncture is effective. Quite the opposite.

I still understate how much acupuncture has failed all of the carefully designed studies to verify its effectiveness. Studies have shown that inserting needles in random locations is just as effective as using so-called acupuncture points. Other studies have shown that sham acupuncture, in which the needles do not penetrate the skin but the subject believes they have, is equally effective. And “expert” acupuncturists cannot agree on the location of acupuncture points.

Don’t let the risk of acupuncture or infection get you thinking. Acupuncturists do not have formal medical training and do not use proper sterile procedures. This means they don’t necessarily disinfect their hands or skin at every place they stick the needle. There have been thousands of reports of infections caused by acupuncture (going back decades), some of which have been fatal. Also, because acupuncturists are not part of the health care system, infections are almost certainly underreported.

Acupuncture isn’t going away anytime soon. Because people are making money off of it. And no matter how many studies show that it’s nothing more than fiction, those people will continue to insist on further research. Additionally, they can point to hundreds of poorly conducted studies that claim to show benefits and claim: post This column also states that “further research is needed.” I’m not making this up. That exact phrase appears in Dr. Pasricha’s article.

There are even scientific journals devoted entirely to acupuncture (e.g. here and here), and the commercial publishers who publish them can also make money. Therefore, even if acupuncture has no effect at all, more studies will be conducted, some of which will be positive.

nevertheless, washington post We can and should do better. My (free) advice to anyone considering acupuncture is: Save your money and just take ibuprofen.