My last blog post was about alternative medicine in cancer treatment. That piece was about patients who refuse all other treatment, and thankfully that is still a relatively rare occurrence. Usually, patients use alternative medicine alongside their regular treatment. As a result, studying patients who refuse all regular treatment isn't necessarily the most informative thing.Because of this distinction, researchers from Yale decided to have a look at patients who do this, and they published their results this month. It is not encouraging reading.The research showed that if patients used alternative medicine at the same time as conventional medicine, they were twice as likely to die in the 5 years after diagnosis. I will get into the details and the numbers below, but first I want to repeat that statement. If patients used alternative medicine at the same time as conventional medicine, they were twice as likely to die in the 5 years after diagnosis. That is a shocking toll.Before I get into the study itself, I want to briefly explain this result. Essentially, if someone uses alternative medicine, they are more likely to refuse other parts of the treatment. So this terrible loss of life is probably not because a specific alternative medicine was causing a problem, but because the belief in pseudoscience has corroded and undercut the public’s trust in medicine. People believe that their alternative treatment is viable replacement for conventional therapy.This belief has not sprung out of nowhere; an entire industry has been built on the idea that medicine is “toxic”, and that if something is “natural” it is automatically better for you.I know so many people who use alternative medicine, from acupuncture, to supplements, to homeopathy, and they often say “what’s the harm?”. Well, this is the harm. Because of the normalisation of this kind of thinking, patients are making bad medical decisions, and are dying as a result. I will say it again: patients who used alternative medicine at the same time as conventional medicine were twice as likely to die in the 5 years after diagnosis.So what does the science actually tell us? Research from a few years ago showed that if someone uses alternative medicine, they are more likely to skip certain parts of their treatment. However, that study didn’t look at how this impacted their survival. This new paper takes that finding and looked at a larger population of patients to see if the use of alternative medicine alongside conventional treatment had any affect (good or bad) on cancer.Firstly, the authors confirmed that in their population of patients, those who used alternative medicine were far more likely to refuse or skip part of their treatment. This included surgery, radiotherapy, chemotherapy and hormone therapy.For example, 7% of patients who used alternative medicine refused surgery, while only 0.1% of other patients did. 34% of alternative medicine using patients refused part of their chemotherapy, while only 3% of other patients did. In a way, this is understandable: these treatments are hard, and make people feel awful. If you already believe that your side effect free alternative medicine is a viable replacement for your chemo, then skipping a round of chemo doesn’t seem like that big a deal.Just to be clear, interventions like surgery, radiotherapy or chemotherapy are not used because we think they improve survival; they are used because we know it. Huge numbers of clinical trials have been done to figure out what allows patients to live longer, and these treatments do that. And refusing some of these seems to be what is doing the damage in patients taking alternative medicine.There is not much more I can really say about this study, apart from the usual caveats. A lot of patients lie to their doctors about their use of alternative medicine, so that could be a confounding factor. The authors were very strict with their criteria, so as a result, the study was relative small, with only 258 alternative medicine-using patients. That being said, it is the biggest study we have on the topic, and the analysis was very rigorous.What this study really shows is the harm that the “natural” industry is doing. Vaccination rates are falling all around the western world. Species are being wiped out because of the popularity of traditional Chinese medicine. But perhaps most damagingly, a third of the American population regularly use alternative medicine without any evidence that is has any effect, spending nearly $200 billion in the process. With such a huge number of people using it, and with the credulous treatment it receives in Hollywood and other media, it is no wonder that people assume it works. It has been marketed and accepted by a large number of people as a true alternative to medicine, and as a result, people are dying for no reason.This is why it is so important to call out pseudoscience when it comes up. We live in a world where medicine is advancing on a daily basis. We can live longer, healthier lives, but people are increasingly taking that for granted and turning towards pseudoscientific ideas, because they are more "natural". The reality is that the more people who understand that alternative medicine does nothing, the better.
Alternative medicine and cancer survival
I often wonder just how much I annoy people when the topic of alternative medicine (alt med) comes up. In general, if someone says something I don’t agree with, I let it slide. When it comes to alt med, however, I don’t seem to have the same restraint. It’s unfortunate really, as it comes up surprisingly often, and my position comes across as pretty extreme.People ask “What’s the harm?”, and point out that “Even if it doesn’t do anything, people feel better having tried it”. I empathise with this position, but completely disagree. The point I try to make is that if we accept the use of alt med, we legitimize it, making people more likely to choose it over conventional medicine.
The focus of this post is cancer patients who put all their trust in alt med. While it's true that most people use alt med alongside real medicine, the popularity of, and belief in, the alt med movement means that it is inevitable that some people will ignore mainstream medicine in favour of alternatives.Unfortunately this does happen, and it happens regularly enough for us to study it. A few months ago, researchers from Yale published a paper looking into the outcomes for cancer patients who chose alt med over conventional treatment.The authors chose four types of cancer to look at: breast, prostate, lung and bowel. Additionally, they chose patients who had early stage disease, so had a good chance of surviving their cancer.Before I get on to the results of their study, one interesting thing to note is that the researchers show that the patients who rejected conventional treatment were more likely to be younger, healthier, more highly educated, and female. These are the patients who would be expected to have better outcomes than other cancer patients, to survive longer and to have fewer complications. However, that is not what the researchers found.Unsurprisingly, the patients who chose alternative medicine were far more likely to die from their cancer than those who didn’t. In the case of breast cancer, alt med users were nearly 6-times as likely to die. In colorectal cancer they were 5-times as likely. In lung cancer they were twice as likely. To put it simply, choosing alternative medicine above conventional therapy kills cancer patients.So, if 100 women with breast cancer were on conventional therapy, 13 would be expected to be killed by their cancer in the 5 years after diagnosis. If the same women were on alternative medicine instead, 41 of them would be expected to be killed over the same time. It is a damning example of the damage alt med can do.
As always, there are a few caveats with this study. One is that these patients completely rejected conventional therapy. Patients who combined it with conventional therapy were included in the conventional arm, so this study can't say anything about the benefits/damage of that situation.It is also likely that these numbers quoted above are an underestimation. Patients who started using alternative medicine, but switched to conventional therapy (when they realise it was not working) will have been counted in the conventional therapy group, meaning that in reality the use of alt med is probably doing even more damage than described in this paper.This all brings me back to my original point. When people give alt med a sheen of validity by claiming it works, it starts to be seen as a true alternative to our tried and tested treatments. The reality is that it simply isn't. As long as it has some legitimacy, a proportion of the population will use it instead of real medicine, at best wasting money, and at worst seriously damaging their own health. I argue with people about alt med because if I don’t, I feel like I am tacitly agreeing that it has some clinical use, when I know it is not true.To paraphrase an old saying, you know what they call alternative medicine that has been shown to work? MEDICINE. And real medicine saves lives.
Eggs, cancer, and motivated reasoning
The following headline in the The Daily Express caught my attention this week:
“Ovarian cancer - could EGGS be the cause of disease? Vegan charity research REVEALED”Express.co.uk 14th March 2017
The article goes on to explain that a Bristol based charity called Viva! Health has urged consumers not to eat eggs, claiming that one egg a week increases cancer risk by up to 70%. According to their own website, Viva! Health is a science-based health and nutrition charity, and being “science-based” you would expect them to have sufficient evidence to make a claim as eye-catching as the one above. So is this the case?
Viva! Health claim that eggs are linked to ovarian and prostate cancer in two ways. First, the high cholesterol levels promote these cancers; and second, choline in eggs is linked to prostate cancer. They give references to scientific publications as evidence, but these publications show nothing of the sort. The journal article they point to regarding cholesterol explicitly states that any association between egg consumption and ovarian cancer risk is not due to the cholesterol in eggs. A quick look at the literature also shows that if there is any link between egg consumption and breast or prostate cancer, it is tiny. A similar pattern holds true for the link between choline and prostate cancer. The research that Viva! Health use to support their claim actually shows the opposite, that choline from eggs is not associated with cancer. It’s pretty clear, there’s nothing to worry about.It took me roughly six minutes to debunk both of these claims, using the identical publications that Viva! Health used to support their claims, so an obvious question is how a charity that clearly thinks of itself as “science-based” could come to the opposite conclusion to me. There is a well-known phenomenon in psychology called motivated reasoning. It describes a process by which someone who holds a particular belief seeks out information that confirms what they already believe, rather than rationally assessing the evidence.It is a fascinating mental trick that we are all guilty of. We all cling to different beliefs with different strengths. If I was to tell you that plastic bags are more environmentally friendly than cloth bags (unless the cloth bag is used more than 130 times), you are likely to look at the evidence and relatively quickly change your view without a huge amount of argument. On the other hand, if I was to say that immigration is economically bad for a country (or good depending on your point of view), you are far more likely to argue with me and ultimately reject that argument. Although both the plastic v cloth and the immigration arguments are contentious and depend on the studies you look at, the likelihood is that you reacted differently to each.A lot of recent research has started to dissect these distinct types of beliefs. We have normal beliefs that change with additional information, but we also have a set of beliefs that form the core of our identities. These often take the form of religious or political views, and when these beliefs are challenged we don’t take a rational approach. Instead we employ motivated reasoning, dismissing awkward facts and cherry picking the ones that agree with us. Indeed, if one of these core beliefs is challenged, it is likely that the belief will be ultimately strengthened rather than weakened by the challenge, something called the backfire effect.Motivated reasoning is extraordinarily common in pseudoscience. Topics like climate change and vaccine safety have decades of reputable research behind them, but despite this, deniers ignore the body of evidence and scientific consensus, deciding to rely on small bits of circumstantial evidence or simple untruths to “prove” their points. There seems to be very little we can do to convince people who hold these beliefs so tightly. However, the majority of the population doesn’t have beliefs like this at the core of their identity. They may have heard the arguments and be unsure about the topic, but with clear evidence and explanation, most people will make the right decisions. This is exactly why it is so important to talk about science and to educate people in how to recognize false claims.Motivated reasoning may be behind the Viva! Health claim that eggs cause cancer. They are a charity dedicated to promoting veganism, so it is entirely plausible that their beliefs regarding non-vegan foods are central to their identity. Alternatively however, they may just understand that if you link something to cancer (whether it is true or not), you are far more likely to make it into the papers, and have random bloggers talk about you!
Does Nutella cause cancer?
On a recent cycling trip in Canada, I ate an obscene amount of Nutella. It works as a great lunch, and dipping fresh bread in it is a delicious snack. When you are exercising all day every day, a tasty, spreadable, dippable energy source like this is extremely useful. Don’t get me wrong, it is a very unhealthy food, but despite this, I’m a fan.Which is why I was surprised this week to see Ferrero (the makers of Nutella) defending their product against claims that it causes cancer. A quick internet search revealed the problem. As the Tech Times put it: “Nutella Can Cause Cancer, Study Warns”. The Huffington Post ran with: “Stores Are Pulling Nutella After Report Links It To Cancer”, while the Daily Mail asked “Could Nutella give you CANCER?”. So what is this all about, and should you stop eating Nutella?As I’m sure you can guess, the simple answer is no, there is currently little evidence to suggest that you need to avoid Nutella. This panic was based on a study released by the European Food Safety Authority (EFSA) last year which suggested that when palm oil is refined at above 200°C, it releases something called glycidyl fatty acid esters (GE). Previous work has shown that at high levels this chemical can cause cancer in rats. Ferraro do indeed use palm oil in Nutella, so people have made an assumption that it therefore contains GE. However, Ferrero have clearly stated that they do not process their palm oil at 200°C, so no GE is produced in the process. Case closed.But for the sake of argument, lets pretend they do refine their palm oil at 200°C. Would the hypothetical amount of GE in Nutella be a cause for concern? In the EFSA report they quote the levels of GE that cause tumours in 25% of rats (10.2 mg/kg/day in case you are interested). Now obviously we would want to play it safe, and wouldn’t want to consume anywhere near that amount. So for argument’s sake, lets see how much Nutella we would need to eat to get 1/10,000th of that amount (thanks to this article for calculating the numbers). It turns out that the average adult would need to eat nearly 100g of the stuff every day to reach 1/10,000th of the amount that gives rats cancer. That’s over two jars a week, and if you are eating that much Nutella, then cancer is the least of your problems. The same amount of Nutella (800g) contains over 450g of sugar, which is double what your TOTAL sugar intake should be for a week.Simply put, concerns about cancer are a terrible reason to stop eating Nutella. Their use of palm oil has many other problems associated with it, including the devastating environmental impact, but that is another argument. As always, this is a case of poor journalism. The study itself didn’t mention Nutella, and was just focused on the GE. Some simple fact checking would have shown that Nutella does not process their palm oil in a way that produces GE, but there is nothing like a food scare to attract clicks.
Kinesio Tape
Anyone who has watched any sport in the last few years will be aware of Kinesio Tape (KT). It’s the coloured tape that athletes wear to recover from/prevent injury. I really noticed it in the 2012 Olympics, when it seemed that every second athlete had some on, and it is still extremely prevalent.
Manufacturers of the tape claim it can alleviate pain, reduce inflammation, relax muscles, enhance performance, and help with rehabilitation as well as supporting muscles during a sporting event. Furthermore, it can be used for hundreds of common injuries such as lower back pain, knee pain, shin splints, carpal tunnel syndrome, and tennis elbow, just to name a few. And all of this for as little as £8 per roll.Any product that claims to have such wide-ranging benefits deserves some scrutiny. So what evidence is there for KT effectiveness? Well, surprisingly little. In the last three decades there have been nearly 100 papers published regarding KT. In 2014, Australian scientists reviewed that literature and published their findings in the Journal of Physiotherapy. The paper was entitled: “Current evidence does not support the use of Kinesio Taping in clinical practice: a systematic review”, and the title says it all. They reported that “Kinesio Taping was no better than sham taping/placebo”. Furthermore, in studies that did show an effect of KT, the scientists found that either the effect was tiny and probably not clinically significant, or that the trials were of low quality.A second review in 2013 concluded that “there currently exists insufficient evidence to support the use of KT over other modalities in clinical practice”. It is pretty clear that KT does nothing that ordinary tape doesn’t do.So it’s no better than standard taping; but what does standard taping do? Again, the literature is pretty mixed on this. There is some evidence that taping an injured muscle may help it perform better, just like a brace. It is also thought to offer slight pain relief by structurally supporting a joint, however, a brace is more effective. There is also some evidence that it can improve proprioception (the awareness of where a limb is in space without looking), but this is disputed. Ultimately, taping can help with an injured joint or muscle, albeit in a minor way.So given that using gaffer tape works just as well as KT, why is it that sportspeople spend the extra money on expensive KT? Marketing is the obvious answer. In both the 2008 and 2012 Olympics, Kinesio Holding Co. donated huge amounts of tape to the US Olympic Committee. American beach volleyball player Kerri Walsh embraced the product and the company saw a 300% rise in sales in the immediate aftermath.
Selling to athletes makes perfect sense really. They are well known to be a superstitious group of people, and those superstitions can help them perform better. Michael Jordan played every single game of his career in the same pair of shorts from the University of North Carolina. Serena Williams never changes her socks during a tournament. In the arena of elite sport, small margins can be the difference between winning and losing, so the placebo effect of a particular ritual can be decisive.Ultimately, Kinesio Taping is just the latest in a long list of products that sports people have embraced because they thought it gave them the edge (who remembers those white strips that people used to put on their noses to make it easier to breathe?). Ironically, although these products themselves do nothing, the belief that they do may have a minor effect. Unlike other pseudoscience I have written about, this isn’t a particularly harmful one. So if someone wants to spend their hard-earned cash on magic tape, who am I to object?!
Alternative medicine as a placebo
I recently wrote a post about the decision by NICE to no longer recommend acupuncture for lower back pain. This decision was made because, like most alternative medicine, acupuncture hasn’t been shown to work any better than a placebo. However, plenty of people use and get benefit from such treatments. This raises an interesting question: is there a place for complementary and alternative medicine (as a placebo) in the clinic?
The ethics of prescribing placebos is a complicated topic. People are perfectly entitled to use alternative medicine, and if they get a benefit, that’s obviously good. However, whether a doctor should prescribe alternative medicine is a different matter.As I have previously written, most complementary and alternative medicine works purely on the placebo effect. People argue that alternative medicine should be allowed to be prescribed, because if the placebo effect helps someone, then that justifies its use. Indeed, here in Glasgow we have an NHS funded “homeopathic hospital”, and if it helps people, why should we stop that?Unfortunately it’s not that simple. If a doctor prescribes such a therapy, it has the effect of offering a medical credibility to the therapy that doesn’t work. This may not sound like a big problem, but it is. There are many examples of people eschewing mainstream medicine for “natural” alternatives and herbal remedies.A court in Canada, for example, recently convicted the parents of a child who died from meningitis after they consulted a naturopath rather than a medical professional. The naturopath recommended the parents give ecinachia to their dying child. This isn’t an isolated case; it’s worth visiting the What’s the Harm website to see the toll that belief in pseudoscience can have.The reality is that if a doctor prescribes acupuncture for pain, then a patient is more likely to believe the plethora of false claims that an acupuncturist may make (including it being effective against diabetes, heart attacks, cancer and even ebola). This in turn increases the risk of patients postponing or declining evidence-based conventional treatment when it is needed. It was recently shown that women who were using certain alternative therapies were less likely to start chemo for their breast cancer. Regardless of whether someone benefits from the placebo effect given by an alternative therapy, it is simply not ethical to legitimise it as a practice. Furthermore, it is perfectly possible to give a placebo that does not come with the added nonsense, which brings me on to my next point.In 2008, the American Federal Trade Commission made a ruling on the use of the Q-Ray Ionised Bracelet in medicine. The makers argued that they could claim it was a cure for chronic pain because, like acupuncture and other alternative medicine, it exhibited the placebo effect. In his ruling on the case, the judge said the following:
“Like a sugar pill, it alleviates symptoms even though there is no apparent medical reason. Since the placebo effect can be obtained from sugar pills, charging $200 for a device that is represented as a miracle cure but works no better than a dummy pill is a form of fraud.”
When we can get the same or similar effects from a far cheaper placebo, then a doctor prescribing alternative medicine is ripping off their patient or the NHS. With already stretched resources, it is scandalous that the NHS pays £1.33 million per year to the Glasgow Homeopathic Hospital. People spend a huge amount of money on alternative medicine (it’s a $34 billion industry in the US), a product that doesn’t work, and is also completely unregulated.The unregulated nature of the industry is something that people are generally unaware of. Numerous studies have shown that alternative remedies regularly contain contaminants like toxic metals, pharmaceuticals, insects, rodents, parasites, fungi, pesticides and other fillers. These contaminants have led to serious illness is many cases, and several deaths. Prof. Edzard Ernst (former Chair in Complementary Medicine at the University of Exeter) has written extensively about this topic and is a good place to look for more information.The placebo effect has a significant role to play in health care. It can undoubtedly improve subjective symptoms in a number of contexts. However, while any effect alternative medicine has can be explained by placebo, the industry claims that it does much more than that. Couple this with the unregulated nature of the products and the expense involved, and it is clear that alternative medicine should never be given legitimacy by the mainstream medical community. I’ll leave you with this quote from Tim Minchin:
"By definition", I begin"Alternative Medicine", I continue"Has either not been proved to work,Or been proved not to work.Do you know what they call "alternative medicine"That's been proved to work?Medicine."
https://www.youtube.com/watch?v=HhGuXCuDb1U
Acupuncture no longer recommended for back pain
NICE (the organisation that provides guidance to doctors in the UK) recently updated their recommendations regarding lower back pain. In the updated guidance, they say that exercise, in all its forms (for example, stretching, strengthening, aerobic or yoga), is the most important step in managing back pain. Previously, NICE also recommended acupuncture or massage, but this has now been altered. Massage can still be used alongside exercise, but the guidelines no longer recommend acupuncture, as "evidence shows it is not better than sham treatment".This is not entirely surprising as, despite widespread acceptance of acupuncture, the evidence that it works for any illness or disability is very scant (as I have described in a previous post). Most studies are poorly carried out, and many show no difference between it and sham acupuncture.Unfortunately, the authors of these studies often conclude that both acupuncture and sham acupuncture work, rather than the actual conclusion (that acupuncture doesn't work). If a medicine works no better than a sham medicine (a sugar pill for example), we cannot conclude that both the medicine and the sugar pill work.For those suffering from back pain, the new recommendations also encourages people to continue with normal activities as far as possible, and recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried. Unfortunately, at present there is no evidence to back up other interventions.A recent study found that back pain caused more disability than any other condition, and is also responsible for 37% of all chronic pain in men and 44% in women. While it is understandable that people seek relief from their symptoms, it is obvious that the NHS can't fund a treatment that does not work.
Can Wi-Fi make you sick?
A French court recently awarded a disability grant to a woman claiming to suffer from electromagnetic hypersensitivity. Sufferers define this as an illness caused by the radiation given out by everyday objects (Wi-Fi routers, mobile phones and power lines, for example), resulting in a wide range of non-specific symptoms, including headaches, fatigue and irregular heartbeats. There have been several lawsuits in the US from people claiming that their health has been affected by Wi-Fi (unsuccessful so far), and just this week in Massachusetts parents have sued a school, claiming that the Wi-Fi there made their son ill.
While sufferers may have very real symptoms, we can be extremely confident that they are not as a result of exposure to electromagnetic radiation, and all reliable evidence suggests that electromagnetic hypersensitivity does not exist as an illness. Many studies have now been conducted to test whether the everyday electromagnetic radiation is causing the symptoms that sufferers display.For example, trials have exposed sufferers to either electromagnetic radiation or not, and tested whether the patients can tell the difference (they can’t), or whether there are increased stress hormones in their blood (there isn’t). Alternatively, study participants’ can be given protective netting designed to shield them from electromagnetic fields, sham netting or no netting, and tested to see if their symptoms get any better when shielded (they don’t).A 2010 review of the literature gathered evidence of 46 published papers on electromagnetic hypersensitivity and stated that the authors were “unable to find any robust evidence to support the existence of (electro-magnetic hypersensitivity) as a biologic entity”. Furthermore, the WHO took into account a staggering 25,000 articles, published over the last 30 years, analysing the biological effects and medical applications of non-ionizing radiation and concluded that “current evidence does not confirm the existence of any health consequences from exposure to low level electromagnetic fields”.The most likely explanation is that these symptoms are caused by the nocebo effect. This is the opposite of the placebo effect, so rather than people feeling better when they think they have been given a treatment, they feel worse when they think they have been exposed to something harmful. The symptoms that they feel may be entirely real, but they are almost certainly psychological. In an experiment carried out in 2013, scientists showed half of their subjects an episode of the BBC series “Panorama,” which alleged that WiFi signals were harmful. They then exposed the whole group to a fake Wi-Fi signal and waited to see who would get sick. The ones who watched the documentary were far more likely to develop electromagnetic hypersensitivity symptoms, providing strong evidence that the nocebo effect plays a large role in this syndrome.The judge in the case in France accepted that the woman’s symptoms prevented her from working, but stopped short of recognising electromagnetic hypersensitivity as an illness. This however hasn’t stopped believers from claiming this as a major breakthrough which proves that it is not a psychiatric illness. It doesn’t help when so many news outlets report so credulously on this story. Unfortunately, this court case has given legitimacy to believers in this syndrome, which could have much wider consequences. An industry has sprung up, selling products that claim to protect people from this harmless radiation, exploiting sick and vulnerable people. Unfortunately, this court case will only make this easier.
Have we explained how acupuncture works?
Acupuncture is a topic that divides people. It is seen by some as a little understood branch of medicine, by others simply as pseudoscience. The theory states that inserting needles at specific points can have effects on almost every ailment, from chronic pain and allergies to irritable bowel syndrome and even stroke. At present, however, there is little reliable evidence that acupuncture works any more than placebo, which makes this article from The Guardian quite unexpected:
Rats help scientists get closer to solving the mystery of acupunctureThe Guardian - 21/07/2015
The title is surprising because this was not a report on acupuncture. The scientists applied an electric current through the acupuncture needles. This technique is called transdermal electrical stimulation and is already used in the clinic to treat chronic pain. The authors, however, call it “electroacupuncture“, and equate it to acupuncture. They are not the same thing, and the conclusions are hence not about acupuncture at all.Scientifically there are many other problems with this study. This was a tiny experiment, with only 7 animals being tested with the “electroacupuncture”. It was not blinded, meaning that the experimenters knew what treatment they were giving to each animal. You may not think that this is an important issue, but consider this: studies on acupuncture in the West yield very mixed results, leading us to believe that the effects are either tiny or non-existent. In China, Japan and Taiwan, where there is a culture of belief, almost every single study shows a positive result. The belief of the experimenter can drastically influence the result of an experiment. Blinding is essential in such studies to overcome this.It is also worth drawing attention to the controls used in this study. The experimenters compare “electroacupuncture” to two controls: sham-acupuncture and no acupuncture. Sham-acupuncture is specifically in place to test for the presence of the placebo effect. Depending on the study, sham-acupuncture can be one of a few things, from inserting the needle at a random point in the body to the use of needles that retract into the sheath, so there is no penetration of the skin at all. In this study, the authors used the insertion of their electric needle at a non-acupuncture point as the sham.Tellingly, the authors did not report any difference between sham-acupuncture and acupuncture. The fact that this isn’t reported, and a look at the data presented in the paper, suggests that there is no difference between their “electroacupuncture” and sham. They only report that “electroacupuncture” seems to be slightly better than the no treatment control. So not only their results are unspectacular, but can be entirely explained by placebo effects. It is worth pointing out that the placebo effect can be extremely powerful, and people can see vast improvements when using any therapy that may not be due to the therapy themselves, but down to the placebo effect. This is why we control for it in trials.This control issue with the study is one that is common with other acupuncture research. It is regular these kinds of studies to see no difference between acupuncture and sham-acupuncture, and rather than conclude that acupuncture doesn’t work, they conclude that both acupuncture and sham-acupuncture work, and this is just not true! If a drug had the same level of effect as a sugar pill, we wouldn’t conclude that both are working. Unfortunately, it is rare for studies into pseudoscience to hold themselves to the same standards.Put simply, this is a badly designed study, from which the authors conclude that acupuncture works, seemingly without actually looking at acupuncture at all. At present, we cannot even say that there is a “mystery of acupuncture”, as described in the headline of this article. There is no mechanism in science or medicine through which sticking needles into particular points around the body can have very specific effects on other parts, so to claim acupuncture works would require convincing evidence (extraordinary claims require extraordinary evidence). This is certainly not that.
