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The trouble with acupuncture studies

August 24th, 2010

Tara Parker-Pope has an interesting article in the New York Times about a recent study on acupuncture for pain relief, and more generally about the difficulties in testing acupuncture (and other forms of “traditional” or “integrative” medicine) using standard Western research methods.

The study tested acupuncture versus a sham treatment (that also involved needles, but inserted in the “wrong” places and not as deeply) in 455 patients suffering from knee arthritis. Both groups experienced relief — their pain decreased by one point on a scale of 1 to 7 compared to controls who received no treatment at all. This is consistent with a series of earlier studies suggesting that “inserting needles in or around an area of pain may have caused a ‘super placebo’ effect, touching off a series of reactions that changed the way the body experienced pain.”

The NYT article is worth reading for the discussion of what can and can’t be tested with traditional blinded clinical trials. And then there’s the even harder question: if the effects of acupuncture are essentially a placebo, but a powerful one, then what do we do? After all, the results — pain relief — are surely more important than the mechanism. But what if we establish once and for all that it’s a placebo. Does that mean its effectiveness will disappear? Is it better to remain ignorant so that treatments like acupuncture will work?

  1. Jeff
    August 24th, 2010 at 19:43 | #1

    Ignorance is never a good option with your health.

    Steven Novella says it better than I can: http://www.sciencebasedmedicine.org/?p=4304

    “Existing evidence strongly suggests that placebo effects are mostly comprised of bias in reporting and observation and non-specific effects. There is no measurable physiological benefit from placebo interventions for any objective outcome. There is a measured benefit for some subjective outcomes (mostly pain, nausea, asthma, and phobias), but the wide variation in effect size suggests this is due to trial design (and therefore bias) rather than a real effect.

    In any case, any perceived benefit in subjective symptoms seems to be greater for physical interventions (perhaps a hands-on benefit) but is the same for mainstream vs novel treatments.

    Therefore, there is no justification to be found in the placebo effect for using unscientific or dubious interventions. Placebo medicine is a sham. And any potential placebo benefit worth having can be fully realized with science-based interventions.”

  2. alex
    August 24th, 2010 at 22:15 | #2

    That science-or-nuthin’ position is certainly my first instinct too, Jeff. In fact, it’s one of the prime motivators for this blog. On the other hand, I see more and more research about the brain’s role in areas where I would have thought simple physiology would dominate (for instance, the limits of fatigue in physical performance). That doesn’t mean I think “science” is somehow incomplete, but rather that current experimental methodologies may be poorly designed, in some cases, to measure outcomes that depend in part on brain-body interactions.

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