Furosemide is good for filling the patient’s bladder, but the patient probably did not call for help filling his/her bladder.

- Rogue Medic

Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone

In EMS back pain is almost a requirement. What is the best treatment for back pain?

The Archives of Internal Medicine published a study of several different treatments for back pain.[1] The results show that acupuncture plus conventional treatment produced better results than conventional treatment alone. The difference is significant. Is there any reason to believe that this is something more than the placebo effect?

This study included a placebo acupuncture group, just to answer that question. The shocking news is that the placebo acupuncture group responded the same way the genuine acupuncture group responded.

In other words, the placebo and the treatment are indistinguishable.

Placebo Acupuncture = Acupuncture = Placebo

All of the patients were receiving conventional treatment. Some had different treatments added. The added treatments were:

Standard, but genuine acupuncture.

Individualized, but genuine acupuncture.

Fake acupuncture.

No shock that the added treatments produced a placebo effect. That is the way placebos work. This is also the treatment group most likely to respond to placebo treatment. Pain treatment is where the placebo effect really looks good.

The results are that there is a placebo effect. In this study, the placebo effect is the same, regardless of whether the added treatments is an admitted placebo (sham acupuncture) or not (genuine acupuncture or even the individualized acupuncture that takes advantage of all of the extra that an expert acupuncturist can add). Even the high potency acupuncture is no more effective than fake acupuncture.

The interesting thing is that the researchers try to find ways to explain why the sham acupuncture is effective that does not involve the use of the placebo effect. That would require that they look at the genuine acupuncture a bit differently.

Apparently the researchers have taken an especially potent dose of Cognitive DissonanceTM.

There is an older study – 2008 – that shows that sham acupuncture works better than genuine acupuncture.[2], [3] This study has the same problem for the researchers. How do we explain the placebo being better than the acupuncture? Here is a graph of the response of patients to treatment.

Click on the image to make it bigger and more detailed.

The dotted lines are the fake acupuncture group. The solid lines are the genuine acupuncture group. The lower they are on the graph, the lower the level of pain. The bad news for acupuncturists – the pain relief was greater with fake acupuncture. The good news for patients – there is no good reason to spend money on this placebo.

If you want a placebo, it is better to get a really inexpensive placebo.

There is a more in depth discussion of this over at Respectful Insolence.[4]

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Footnotes:

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[1] A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.
Cherkin DC, Sherman KJ, Avins AL, Erro JH, Ichikawa L, Barlow WE, Delaney K, Hawkes R, Hamilton L, Pressman A, Khalsa PS, Deyo RA.
Arch Intern Med. 2009 May 11;169(9):858-66.
PMID: 19433697 [PubMed - in process]

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TM Cognitive Dissonance
Wikipedia
How to harm people with a clear conscience. Fool yourself.
Article

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[2] Acupuncture for treatment of persistent arm pain due to repetitive use: a randomized controlled clinical trial.
Goldman RH, Stason WB, Park SK, Kim R, Schnyer RN, Davis RB, Legedza AT, Kaptchuk TJ.
Clin J Pain. 2008 Mar-Apr;24(3):211-8.
PMID: 18287826 [PubMed - indexed for MEDLINE]

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[3] Sham device v inert pill: randomised controlled trial of two placebo treatments.
Kaptchuk TJ, Stason WB, Davis RB, Legedza AR, Schnyer RN, Kerr CE, Stone DA, Nam BH, Kirsch I, Goldman RH.
BMJ. 2006 Feb 18;332(7538):391-7. Epub 2006 Feb 1.
PMID: 16452103 [PubMed - indexed for MEDLINE]

Free Full Text from PubMed Central.

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[4] Another acupuncture study misinterpreted
Science Blogs – Respectful Insolence
Article

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Trackbacks

  1. [...] response to Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone, there is a comment by RavenBlack. You are mistaken, or at least the study (and other studies) [...]

  2. [...] Acupuncture, homeopathy, naturopathy, reiki, et cetera repeatedly fail that requirement. These are examples of alternatives that repeatedly fail to outperform wishful thinking. Even when studied by people who are proponents of wishful thinking. Wishful thinking is not an alternative to real medicine. [...]

  3. [...] that the acupuncture researchers applied, however unintentionally, in the studies I wrote about in Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone. Precordial thump is proposed as a complementary treatment – not an alternative [...]

  4. [...] Acupuncture, homeopathy, naturopathy, reiki, et cetera continually fail to demonstrate that they are any better than a placebo. These treatments are overturned by science, but they were never supported by anything that could be called good science. They have only been supported by poorly done science or by the rare example of the law of large numbers. [...]

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