Without evidence of benefit, an intervention should not be presumed to be beneficial or safe.

- Rogue Medic

Eureka – Conventional Treatment Plus Placebo Beats Conventional Treatment Alone – comment from RavenBlack

Also posted as part of the Skeptics’ Circle over at Pro-science. Go check out the rest of what is there.
 

In 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) doesn’t support what you say.

 

This study,[1] and other studies, make it clear that benefits of acupuncture are nothing more than the placebo effect. In the 2008 study,[2] the fake acupuncture was significantly more effective than real acupuncture.

How bad is a treatment, when faking the treatment is more effective than the real treatment?

At least, with real medicine, treatments that are demonstrated to be no more effective than placebo, are not adopted, or are discarded if they ever had been mistakenly adopted. To keep using these treatments would endanger patients. With alternative medicine, they just come up with excuses for continuing to use the failure. Alternative medicine is both a medical failure and an ethical failure.

Suppose the patient had subcutaneous emphysema, cysts in need of drainage, boils needing to be lanced, . . . there would be a medical benefit from the treatment? 😉

Back to the comment:
 

“Maybe, but it won’t make any more difference than any other placebo. Placebos can be helpful in treating pain. Why not go with something equally effective, but less expensive, less potentially infectious, and less involved?”

Different placebos have different levels of effect; in fact, between sugar pill A ($2, generic box) and identical sugar pill B ($10, posh-looking box) pill B is statistically significantly more effective. The cost (financial and otherwise) of your placebo makes it more effective, so you can’t just go with something equally effective, less expensive and less involved. The effectiveness is (to a point) proportional to the expense and involvement – which is why acupuncture is one of the better placebos!

 

It is true, that the perceived cost of the placebo influences the placebo effect. If you know that it is all placebo, the pill should not have any effect. The same is true for the acupuncture, since it is all in the mind, or changes produced by the mind. However, this is not true for some of the side effects of acupuncture, such as infection.

Why do proponents of alternative medicine continually defend telling lies to patients?

Look at the wonderful placebo effect!

Ooh! Ahh!

The study did not address cost, or at least did not mention it. I was just editorializing. I stick to generic medicines, because the added cost of name brand medicine is only an effective placebo if you believe that the more expensive it is, the better it is. I do not.

I have bills to pay, so there is no reason for me to waste money on something that is just an attempt to influence my perception of treatment.

There is already too much waste in health care. We should get rid of treatments that are nothing but placebo, or at least encourage lawyers to sue the practitioners for malpractice fraud. Malpractice would suggest that there was some medicine involved. Fraud is just an alternative name for alternative medicine.

Perhaps, people should buy expensive placebos from trusted family members.

Then there is the problem of whether treating with placebos is ethical. Of course, ethics is something that is a part of real medicine, but not a part of alternative medicine fraud. After all, treatment with alternative medicine is fraud.
 

(Also it has added “lying there and relaxing” over most placebos, which calls for a separate study since it may be the “lying there and relaxing” effect at play in this study, rather than [or in addition to] the placebo effect.)

 

The fake acupuncture had the same conditions as the real acupuncture, except that no needles were placed and in the first study. but not the second[2*] different sites were used for the imitation needles. The patients were not able to tell which treatment they were getting. Therefore, I do not see any reason to conclude that the fake acupuncture is anything other than an excellent imitation of real acupuncture. The real acupuncture, and even the super duper individualized acupuncture, did not do any better than imitation acupuncture.

Any untrained person was just as effective as the most highly trained acupuncturist. It is all about putting on a good show. Otherwise, there should have been some difference between the expert individualized acupuncture and the fake (intentionally wrong) acupuncture.

The older study showed that the real acupuncture did not even do as well as the fake acupuncture.

They could add in all sorts of treatments (such as relaxation) to compare them with acupuncture, but if real acupuncture is not as effective as an indistinguishable placebo, these studies would just be a waste of time, money, and opportunity. All of these could go toward treatments that might actually do some good – other than just doing good for the acupuncturists’ bank accounts.

This kind of rationalization only encourages the acupuncturists to keep trying, hoping that random variation in study participants will lead to them studying a very suggestible group that disproportionately falls into the treatment group.

The only reason to continue to study acupuncture would be the possibility that it does have a replicatable effect on some specific condition, but where is the evidence of that? And why keep trying with such a blatant failure? Time to give up and work on real medicine.
 

You seem to support the use of placebo, as long as it is expensive enough to bleed the patient, but not expensive enough to kill off the golden goose.

If the treatment becomes more effective as the price goes up, for some people, does that mean that we should raise the prices of all treatments, to get the most out of them.

You seem to suggest that an effect is all the justification needed for a cost, or even raising the cost. A treatment may be effective, but not worth the cost. An ineffective treatment is just not worth the cost, no matter how much you like alternative placebo medicine.

Patients with too much money, and not enough sense, may eventually find an equilibrium. With the health care reform proposals and the whining from Dr. Sen. Tom Harkin, that science us unfair to his alternative medicine nonsense, there will probably be more money wasted on this fraud. That deprives patients of effective treatments.

Of course, science is unfair to nonsense. Science is a way of identifying nonsense. The only surprise is that so many people are too gullible to understand that acupuncture is pure nonsense. The individualized acupuncture, which is the higher quality treatment from the acupuncture specialist, is also pure nonsense, just nonsense with better publicity.

The whole purpose of science is to be a nonsense detector (or a BS detector). Alternative medicine has been repeatedly failing its attempts to be categorized as anything other than nonsense, because alternative medicine is nonsense.

Science discriminates against nonsense.

Nonsense should be discriminated against.

Alternative medicine discriminates against patients.
 

Placebo Acupuncture = Acupuncture = Placebo

Placebo Acupuncture = Expert Acupuncture = Placebo
 

Remember, if alternative medicine worked, it would be able to get rid of the name alternative and just call itself medicine. Just the same as all of the other traditional treatments that have been able to show that they are better than placebo – more effective, fewer side effects, et cetera.

Alternative medicine is just another way of saying failure.

Alternative medicine practitioners are the Bernie Madoffs[3] of medicine – all fraud, all the time.

Acupuncture – It isn’t medicine, but the cost is real.

Footnotes:

[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

Free Full Text from PubMed Central.
 

In conclusion, acupuncture-like treatments significantly improved function in persons with chronic low back pain. However, the finding that benefits of real acupuncture needling were no greater than those of non-insertive stimulation raises questions about acupuncture’s purported mechanism of action.

 

[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

[2*] Correction 01-07-2019 and 01-08-2019 – In this study real acupuncture sites were used, but not real needles, so this only examined the justification for using needles, not the effect of the locations. The other study[1] did use fake acupuncture locations and did show that the location also does not matter.

In a twist that the acupuncturist cannot explain, the patients outcomes were significantly better in the group that did not use real needles.
 

The sham group improved significantly more than the true acupuncture group during the treatment period, but this advantage was not sustained 1 month after treatment ended. The difference in pain between sham and true acupuncture groups at the end of treatment (0.75 points on 10-point scale), although statistically significant, probably does not represent a clinically discernible difference.

[3] Bernard Madoff
Wikipedia
Article

Added 01-10-2019 – In going through some old sources, I have been making a few corrections and occasionally adding updated information, such as this more recent study showing that acupuncture is just a placebo –
 

Acupuncture for Menopausal Hot Flashes: A Randomized Trial.
Ee C, Xue C, Chondros P, Myers SP, French SD, Teede H, Pirotta M.
Ann Intern Med. 2016 Feb 2;164(3):146-54. doi: 10.7326/M15-1380. Epub 2016 Jan 19.
PMID: 26784863

Free Full Text in PDF format from carolinashealthcare.org
 

CONCLUSION: Chinese medicine acupuncture was not superior to noninsertive sham acupuncture for women with moderately severe menopausal HFs. (Hot Flashes)

 

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