Acupuncture

Discussion in 'Health and Fitness' started by RickyC123, Jan 23, 2014.

  1. David Harrison

    David Harrison MAPper without portfolio

    Actually, different placebos work better for different conditions.

    Needles are good for pain, but inert pills work better for insomnia, for example.

    Here's an interesting article:

    "Ironically, says Kaptchuk, it was his success as an acupuncturist that made him leave the profession for academia. “Patients who came to me got better,” he says, but sometimes their relief began even before he’d started his treatments. He didn’t doubt the value of acupuncture, but he suspected something else was at work. His hunch was that it was his engagement with patients—and perhaps even the act of caring itself.

    For his ideas to gain traction with Western doctors, however, Kaptchuk knew he needed scientific proof. His chance would come in the early 2000s in a collaboration with gastroenterologists studying irritable bowel syndrome (IBS), a chronic gastrointestinal disorder accompanied by pain and constipation. The experiment split 262 adults with IBS into three groups: a no-treatment control group, told they were on a waiting list for treatment; a second group who received sham acupuncture without much interaction with the practitioner; and a third group who received sham acupuncture with great attention lavished upon them—at least 20 minutes of what Kaptchuk describes as “very schmaltzy” care (“I’m so glad to meet you”; “I know how difficult this is for you”; “This treatment has excellent results”). Practitioners were also required to touch the hands or shoulders of members of the third group and spend at least 20 seconds lost in thoughtful silence.

    The results were not surprising: the patients who experienced the greatest relief were those who received the most care. But in an age of rushed doctor’s visits and packed waiting rooms, it was the first study to show a “dose-dependent response” for a placebo: the more care people got—even if it was fake—the better they tended to fare."


    - http://harvardmagazine.com/2013/01/the-placebo-phenomenon
     
  2. David Harrison

    David Harrison MAPper without portfolio

    If it's all placebo, sham and "genuine" would be incredibly hard to control for. Until we have a theoretical model for how it might work to test, I will probably not be convinced.
     
  3. David Harrison

    David Harrison MAPper without portfolio

    Stress is not intangible at all. We have a fair idea of the neurological and endocrine systems involved and how that manifests.
     
  4. The Iron Fist

    The Iron Fist Banned Banned

    Now that is an amazing article. There is other Harvard research supporting the science discussed at NIH, but this goes more towards my other post about the effect itself, how much the body has a say as opposed to whatever it's receiving and if that can work in the opposite direction.

    Can a doctor's poor bed side manner somehow negate the effects of almost anything?: 'proven' drugs, acupuncture or even things like chemotherapy? It seems plausible based on this article that the body has quite a lot to say about it on its own, before the actual treatment is considered. Likewise someone is given a pill of pure sugar but told of an effect and the effect might materialize (I still assert it just as easily might not). So given this and the other Harvard research alongside NIH and the various studies, acupuncture again seems to be one of the most consistent ways to invoke a strong placebo like effect even when it's 'fake'!!? Why would we ever give up on a winning horse like that, I don't know. Maybe research into acupuncture can help explain the placebo effect itself because like I said I don't know of anything as consistent as it appears to be. If there's something more consistent let's discuss it (sugar while I love it does not count ;) )
     
  5. David Harrison

    David Harrison MAPper without portfolio

    Because, if acupuncture is pure placebo, and placebo treatments are only limited by our imaginations, then I'd like to think we could be more creative and produce better placebo effects than continuing a stone age practice that even some old rulers of China thought was primitive and ineffective.
     
  6. The Iron Fist

    The Iron Fist Banned Banned

    Well the effects themselves are tangible but I am talking the stress/stressors itself there is no chemical composition for what situations makes you angry or sad it's an intangible thing up to the point your brain and body chemistry react, not unlike some of the environmental factors involved in therapy as well as belief and expectation (no chemical makeup for that either) those are really psychological states of mind too complex to be a simple mix of reagents. The Harvard article seems to suggest those states of mind both conscious as well as subconscious probably play a powerful role in all forms of healing. Acupuncture seems to trigger (pretty consistently for a folk remedy) either or both of those which is why it makes sense you'd see the biggest effect in the management of pain as well as stress-related conditions and why for others treatment might first seem absurd...but it seems to work for some people.

    Listen folks i am not a scientist but here's a theory: I noticed something interesting two things 'ruled out' for acupuncture, smoking and depression are clearly both states where the chemistry of the brain has been altered in one case by foreign chemicals and in the other the brain's own. Both would suggest that the sufferer is in a condition where the body's natural healing system (including perhaps other psychosomatic effects) is compromised. Now it's bugging me to ask this question, what happens when someone who is depressed and has arthritis pain takes real and sham acupuncture? How interesting would it be if they remain depressed (which the research suggests) and their pain doesn't improve at all (research suggests it should). That would either counter the studies that show strong pain management results. But on the other hand what if their pain improved? It might suggest some conditions like nicotine addiction or depression are 'acupuncture-resistant' because of the state of the brain!! :D Maybe some people are naturally resistant to acupuncture's effects just like some people have more trouble than others quitting smoking it really does depend on your brain's chemistry and maybe to a lesser extent, how the body is manipulated. These are interesting questions I want scientists to explore, not give up on. Thanks for the discussion folks and beating up my ideas, I have to jet for now but it was a pleasure.
     
    Last edited: Jan 6, 2016
  7. David Harrison

    David Harrison MAPper without portfolio

    No chemical composition, but it is still neurological reactions to sensory input. The conditions which provoke those reactions are observable and testable. I don't get what's intangible about it.

    Likewise :)
     
  8. The Iron Fist

    The Iron Fist Banned Banned

    Hey right on so forget what I said I was not making my point well, but if the sensory input can be needles or even laser light and like I said the whole setup can consistently trigger placebo healing effects, it seems to become 'placebo+' and we've unlocked some of the mystery of that effect in general by examining something that's been used for a lot longer than other forms of medicine to treat many different things (both reasonable and quite absurd!). What other medical research has gone that far into the body's of mind-body healing potential? If it were sugar pills, and it indeed worked a modest 80% of the time, we could say we just discovered the #1 cheap alternative solution to pain management (over the counter too!) and could probably solve all the prescription painkiller epidemics while we are at it. Oh if only I could treat my lower back pain with sugar, it would be so much cheaper and fewer side effects. Ah to dream :D Cya. Thought this appropriate

    [ame="https://www.youtube.com/watch?v=vLkp_Dx6VdI"]Mary Poppins - A Spoonful Of Sugar (from "Mary Poppins") - YouTube[/ame]
     
    Last edited: Jan 6, 2016
  9. philosoraptor

    philosoraptor carnivore in a top hat Supporter

  10. philosoraptor

    philosoraptor carnivore in a top hat Supporter

    Sorry, I tend to lose conversations, then I'll be walking along and randomly think, HEY, I FORGOT ABOUT THIS. First, the placebo effect does not necessarily represent accurate healing; it can be as simple as, especially in studies where patients are asked to rate their own pain, responding favorably for an authoritative person doing some thing that they say might help you.

    [/quote]

    That's certainly one hypothesis, but there are others, among them questions about experimental design, measurements used and the comparability of the experiments. Remember, the devil is in the details. One question that's always important to ask in a study is asking "What were the scientists actually measuring?" The pain studies may have recorded instantaneous relief, while the addiction and depression studies may have recorded whether or not these conditions were 'cured'. This is one reason why meta-studies can be uninformative, non-comparability of results. If you have two measurements of acupuncture on depression and eight bad trials on back pain, you might conclude that acupuncture is effective 80% of the time!
     
  11. The Iron Fist

    The Iron Fist Banned Banned

    Philo are you saying Dr. Vickers' study is wrong or there are errors? Could you be more specific? When I say that I mean with regard to the design, methodology, and so forth. Meta studies or not can you point to serious academic disagreement on par with Dr. Vickers? I guess I don't count blogs as relevant. I guess that's my point I don't see Dr. Ernst as really providing an equivalent qualitative rebuttal, more of a continuance of a firm position (in other words not a very science-based perspective, more of a hold the line mentality). On one hand you have a serious pile of data and research, on the other mostly speculatives via blog. I'd like to see more research performed and the URLs you are posting seem to advocate the abolishment of all funding??
     
    Last edited: Jan 11, 2016
  12. philosoraptor

    philosoraptor carnivore in a top hat Supporter

    Mostly what I have problems with is the inclusion of studies that lack adequate control. I wrote earlier in this thread, but the use of sham acupuncture is actually a minority of the studies surveyed. They found that the efficacy of acupuncture increased as control decreased. Nevermind their conclusion:

    "Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture."

    This does not speak highly of acupuncture's ability to heal people; without a clear mechanism for how it actually works I'm more inclined to think that the meta study is a case of garbage in, garbage out.

    I don't really see any reason to continue researching this, no. There doesn't seem to be any mechanism in play beyond the placebo effect and poor experimental design. The fact that so very much research has already been done and the benefits of such research are so trifling makes me think that even if acupuncture does have an effect beyond the placebo it is at best marginal and other therapies are more deserving of research. You can only spend your money once, as Pappy Raptor likes to say.
     
    Last edited: Jan 11, 2016
  13. philosoraptor

    philosoraptor carnivore in a top hat Supporter

    If you think more research is needed, I guess my question would be 'why?' What questions are you hoping to answer?
     
  14. David Harrison

    David Harrison MAPper without portfolio

    We have to make it true, dammit! ;)
     
  15. philosoraptor

    philosoraptor carnivore in a top hat Supporter

    ONE MORE TRIAL AND IT MIGHT BE STATISTICALLY SIGNIFICANT

    PS Yo, Iron Fist, that's another thing, only positive results are published. So if you're doing a meta-study to see if something works…
     
  16. philosoraptor

    philosoraptor carnivore in a top hat Supporter

    In fact, I'd say this portion of the Vickers' study is outright dishonest, I've bracketed my comments:

    "Yet many clinicians would feel uncomfortable in providing or referring patients to acupuncture if it were merely a potent placebo (LOL, doctors do it, so it must work!). Similarly, it is questionable whether national or private health insurance should reimburse therapies that do not have specific effects (I don't think I need to even write how laughable this is). Our finding that acupuncture has effects over and above sham acupuncture is therefore of major importance for clinical practice (Baloney- the difference they found was between 30 and 35 on a 100 point scale, hardly clinically relevant). Even though on average these effects are small, the clinical decision made by doctors and patients is not between true and sham acupuncture, but between a referral to an acupuncturist or avoiding such a referral (Controls!? We don't need no stinking controls!!!!). The total effects of acupuncture, as experienced by the patient in routine practice, include both the specific effects associated with correct needle insertion according to acupuncture theory, non-specific physiologic effects of needling, and non-specific psychological effects related to the patient’s belief that treatment will be effective (In other words, we don't know if it's actually doing anything, but people like it so you should recommend it)."

    Honestly. They actually write that you should just ignore the sham controls. They certainly wouldn't have said that if their results were significant. Ask yourself if you would be comfortable holding any other form of medicine to this standard. His recommendation is based entirely on ignoring the controls all together.
     
    Last edited: Jan 11, 2016

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