Archive for month: January, 2017

Review: Steve Novella MD PhD 2015

All of this evidence is in stark contrast to what most people believe about acupuncture. People actually think science supports acupuncture. That simply isn’t the case. Which isn’t really surprising, because we’re talking about a healing system that rests on a belief in auras: an alleged “energy” in and around the body that no one can or has ever actually detected.

Conclusion: Once again we see that the best acupuncture clinical trials show that it does not matter where or if you place the needles. Since these are the two interventions specific to acpuncture, we can conclude (confidently, at this point) that acupuncture does not work and that any perceived benefit from acupucture is due to placebo or nonspecific effects.
The acupuncture industry needs to be called on their continued promotion of a medical modality which has already been shown to be ineffective by clinical research. The mainstream media needs to be criticized for uncritically accepting the propaganda of the acupuncture industry.

J Anesthesia & analgesia. June (14) 2013 

A small excess of positive results after thousands of trials is most consistent with an inactive intervention. The small excess is predicted by poor study design and publication bias. Further, Simmons et al (2011) demonstrated that exploitation of “undisclosed flexibility in data collection and analysis” can produce statistically positive results even from a completely nonexistent effect. With acupuncture in particular there is documented profound bias among proponents (Vickers et al., 1998). Existing studies are also contaminated by variables other than acupuncture – such as the frequent inclusion of “electro-acupuncture” which is essentially transdermal electrical nerve stimulation masquerading as acupuncture.

The best controlled studies show a clear pattern – with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are what define “acupuncture” the only sensible conclusion is that acupuncture does not work. Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research. The most parsimonious conclusion is that with acupuncture there is no signal, only noise.

No doubt acupuncture will continue to exist on the High Streets where it can be tolerated as a voluntary self-imposed tax on the gullible…believing claims that are simply untrue.

Conclusions:
It is clear from meta-analyses that results of acupuncture trials are variable and inconsistent, even for single conditions. After thousands of trials of acupuncture, and hundreds of systematic reviews (Ernst et al., 2011), arguments continue unabated. In 2011, Pain editorial summed up the present situation well:

“Is there really any need for more studies? Ernst et al. (2011) point out that the positive studies conclude that acupuncture relieves pain in some conditions but not in other very similar conditions. What would you think if a new pain pill was shown to relieve musculoskeletal pain in the arms but not in the legs? The most parsimonious explanation is that the positive studies are false positives. In his seminal article on why most published research findings are false, Ioannidis (2005) points out that when a popular but ineffective treatment is studied, false positive results are common for multiple reasons, including bias and low prior probability.”

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 elsewhere.

The placebo and Hawthorne effects compare and contrast in these ways: 

• Both are psychological effects on the participants, causing an effect when the material intervention has no effect.
• Both are effects produced by the participants’ perceptions and reactions; but the former emphasises their response to new equipment or methods, while the latter emphasises their response simply to being studied.
• The leading suspected cause in the placebo effect is the participants’ false belief in the material efficacy of the intervention. The leading suspected cause in the Hawthorne effect is the participants’ response to being studied i.e. to the human attention.
• In both cases, the experimenter may be deceiving the participants, or may be mistakenly sincere, or neutral with respect to the effects of the technology or intervention. In general however, the experimenter appearing to the participant to believe in the efficacy of the intervention, while not essential, may be more, or more often, important to the placebo effect than to the Hawthorne effect.

Positive Thinking
Related to placebos is evidence about how positive thinking can improve heath outcomes. This area shows that healing and recovery is affected by various kinds of positive thinking. This is not mostly about a placebo effect confounding an experiment, but about better medical outcomes for physically treated patients depending on whether they additionally have positive thinking. The mediating causes are probably: effects on pain; on how well we look after ourselves; and on reduction in persistent stress.

Wertli MM et al 

Spine J. May 2014

BACKGROUND CONTEXT:
Psychological factors including fear avoidance beliefs are believed to influence the development of chronic low back pain (LBP).

PURPOSE:
The purpose of this study was to determine the prognostic importance of fear avoidance beliefs as assessed by the Fear Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia for clinically relevant outcomes in patients with nonspecific LBP.

RESULTS:
The most convincing evidence was found supporting fear avoidance beliefs to be a prognostic factor for work-related outcomes in patients with subacute LBP (ie, 4 weeks-3 months of LBP), researchers found an increased risk for work-related outcomes (not returning to work, sick days) with elevated FABQ scores. Fear avoidance beliefs in very acute LBP (<2 weeks) and chronic LBP (>3 months) was mostly not predictive.

CONCLUSIONS:
Evidence suggests that fear avoidance beliefs are prognostic for poor outcome in subacute LBP, and thus early treatment, including interventions to reduce fear avoidance beliefs, may avoid delayed recovery and chronicity.