Space City Skeptics

The Official Blog of the Houston Skeptic Society

More Alternative Medicine in the News…..

with 10 comments

December has seen a big spike in reports on alternative medicine, in particular the practice of acupuncture. Last week, a number of outlets ineptly covered the release of the most current numbers on CAM usage, choosing to simply regurgitate press releases from the National Center for Complementary and Alternative Medicine rather than practice actual journalism. Prior to that, the official journal of the American Academy of Pediatrics had published a blatantly pro-CAM article on pediatric use of alternative medicine in which the authors boldly provided the following gem:

“Formal evaluation has suggested that the quality of RCTs of CAM is as good as that of RCTs of conventional medicine, and the quality of systematic reviews of CAM exceeds that of systematic reviews of conventional medicine.”

This notable diversion from reality was followed up by a healthy, and not at all unexpected, dose of praising anecdotal n-of-1 studies and then blaming difficulty obtaining IRB approval of CAM studies on ignorance of just how wonderful the stuff is.  On Saturday, I was made aware of the habitually woo-friendly U.S. military’s foray into “battlefield acupuncture“. And yesterday, as I sat down to peruse the Sunday paper I happened upon the following article on “Alternative Therapies That Really Work” in Parade Magazine.

Now I am painfully aware of the reality that Parade Magazine is not a medical journal. It isn’t even a popular science magazine like Discover or Scientific American. Its articles barely even qualify as reporting at all. Occassionally entertaining fluff, from cover to cover, just about sums it up.  But it is a source of information that millions of people read each and every week, many of whom very likely consider what they read within to be reliable. And it may be reliable when it comes to the latest news on which actresses still wear fur or who readers think is the hottest celebrity in 2008 (still Jennifer Connelly, always Jennifer Connelly), but it is horrendous when it comes to coverage of medical topics.

It was 2.5 years ago, in June of 2006, when Dr. Isadore Rosenfeld wrote a typical article on acupuncture for Parade. In it, after cherry picking a few positive and negative studies to mention, he cautioned readers that more studies are needed before a conclusion on efficacy could be made. Sound reasonable right? He then included an absurd anecdote, one which he has used before in prior articles and one which was effectively handled by Gary Posner and Wally Sampson 10 years ago:

 “My personal experience with acupuncture helps me keep an open mind. In 1978, I was invited to China to witness an open-heart procedure on a young woman. She remained wide awake and smiling throughout the operation even though the only anesthesia administered was an acupuncture needle placed in her ear.”

Naturally this significantly hampered any chance of most readers taking home the only reasonable conclusion which could be made from the article, that acupuncture had not been proven by appropriate investigation to be effective. It still hasn’t. In fact, the position that acupuncture has no real effect, and not that it hasn’t been proven either way, is well supported by the trend in the literature of increasingly negative results in studies of  increasingly improved design and control.

With the help of a number of “experts”, like the aforementioned Dr. Isadore Rosenfeld and Dr. Mark Liponis, Parade has mishandled the subject of alternative medicine for years. The current example is yesterday’s one page article by Dr. Liponis, who according to his profile,

“…..has always had an interest in holistic health and wellness, and continues to expand his expertise in integrative medicine as Corporate Medical Director of Canyon Ranch.”

I suspect that he is more interested in expanding his bank account by taking advantage of the public credulity more so than his expertise. There certainly is not a hint of any any regarding acupuncture, one of the three alternative modalities claimed to work in the article. Here is what Liponis has to say about it:

What it is: Acupuncture is a traditional Chinese practice involving the placement of very skinny, sterile needles into the skin at specific points located along “energy meridians.”
How it works: Eastern philosophy says that acupuncture affects the flow of qi (pronounced “chee”), or energy, through the energy meridians. Western science reasons that the needles interact with our nervous system, triggering the release of hormonelike chemicals that affect our mood, perception of pain, and immune response. 
What it’s good for: In a 2004 study, acupuncture was shown to be helpful in reducing pain due to knee arthritis. It also could be beneficial for sufferers of post-traumatic stress disorder. And when used along with in vitro fertilization, it may be effective in increasing the odds of success in female conception. Stimulating an acupuncture point in the toe even may help correct the breech position of babies in the last trimester and allow more women to avoid C-sections, according to a study in the Journal of the American Medical Association.

First off, invoking the terminology “western science” is a huge red flag that you will soon be venturing off the well-trodden path of critical thinking on a subject. The scientific method is the same regardless of where you live and this kind of terminology serves the underhanded purpose of attempting to establish a double-standard when it comes to evaluating therapies. Usually when it is mentioned it isn’t long before someone is claiming that it isn’t the right way to study [insert unproven therapy]. Furthermore, some scientists may express the opinion that apparant effects of acupuncture are due to the release of a chemicals within the body, but many would argue that this is putting the cart before the horse. If there is no proven effect, what is the point of attempting to establish a mechanism.

As far as the cherry picked studies chosen by Liponis go, well I think calling them cherry picked pretty much makes my point. Looking at three studies, at least two of which are of very poor quality, is insufficient to make a claim that acupuncture works. Enjoy Steven Novella’s dismantling of the claims of acupuncture’s effectiveness in improving IVF success rates back in November. The study on acupuncture and the repositioning of breech fetuses is equally dubious. It is an unblinded and uncontrolled  study. All three of those aspects make studies on acupuncture very suspect. Virtually all studies on acupuncture coming out of China are positive and should be approached with appropriate skepticism. When replication in a non-Chinese population was attempted by the same study author in 2005, no effect was found. This isn’t suprising as it is a patently ridiculous concept with zero prior-plausibility. Dr. Liponis very likely did not do any research when preparing his article as this information was extremely easy to find.

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Written by skepticpedi

December 15, 2008 at 12:16 pm

10 Responses

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  1. I suppose everyone is entitled to their opinions…
    But just because we don’t understand something doesn’t mean it’s not true.

    Here’s some more research to support the “patently ridiculous” concepts:

    In the 2005 study mentioned by you (Cardini et al., BJOG 112(6): 743-747) the authors state: “The study was interrupted when 123 participants had been recruited (46% of the planned sample). Intermediate data monitoring revealed a high number of treatment interruptions. “… “They do not support either the effectiveness or the ineffectiveness of moxibustion in correcting fetal breech presentation.” http://tinyurl.com/6hcdmp

    In a systematic meta-review of 65 citations including six RCTs (randomized controlled trials) authors of this April 2008 review conclude: Our results suggest that acupuncture-type interventions on BL 67 are effective in correcting breech presentation compared to expectant management. Here’s the source from pubmed: http://tinyurl.com/6pvhks

    A review by Cochrane database in April 2005 (3 RCTs involving 597 women) concluded: “Moxibustion may be beneficial in reducing the need for ECV (external cephalic version), and decreasing the use of ocytocin” although numbers of participants precluded statistical analysis. http://tinyurl.com/56kbky

    An April 2004 study of 240 women published in the Journal of Maternal Fetal and Neonatal Medicine concluded; “Acupuncture plus moxibustion is more effective than observation in revolving fetuses in breech presentation. Such a method appears to be a valid option for women willing to experience a natural birth.” Here’s the pubmed reference: http://tinyurl.com/6fq7w9

    I have no idea how it really works, it just seems to work, somehow. Also, as a physician (MD) who sees patients and works with acupuncturists I have also seen many patients helped by acupuncture. I don’t presume to understand how it works.

    More:
    http://www.usatoday.com/news/health/2008-02-07-acupuncture-fertility_N.htm

    Do you believe it’s unreasonable for a woman to try acupuncture/moxibustion when faced with the alternative of a C-section or manual manipulation of the baby at the time of delivery?

    Respectfully,
    Dr. Liponis

    Dr. Mark Liponis

    December 15, 2008 at 2:43 pm

  2. Welcome Dr. Liponis,

    I’ll be more than happy to take a look at your references and I will reply to your comments in detail in a post in the very near future. One thing I am confused about, however, is if you had such an arsenal of data to support such an incredible claim, why did you choose to only mention one poorly designed study? Did you only take the time to search for the data after the fact?

    skepticpedi

    December 15, 2008 at 3:33 pm

  3. “Do you believe it’s unreasonable for a woman to try acupuncture/moxibustion when faced with the alternative of a C-section or manual manipulation of the baby at the time of delivery?”

    *raises hand*

    Big fan of the C-section here! I’m not a doctor, but rather a recipient. It it seems to me that if a C-section is medically indicated, that the administration of acupuncture is actually jeopardizing the outcome of the delivery by delaying necessary surgery. The average layperson is really not informed enough to make such a decision without the advice of her doctor, and thus relies on her doctor to give her the soundest possible medical advice, based on the soundest high-quality supporting evidence as possible.

    The Perky Skeptic

    December 15, 2008 at 6:52 pm

  4. In all fairness TPS, the use of acupuncture that Dr. Liponis is advocating would not delay a medically indicated C-section. The studies in question looked at acupuncture as a means of altering the position of the fetus long before delivery.

    skepticpedi

    December 15, 2008 at 7:38 pm

  5. But that doesn’t let this article off the hook by a longshot.

    skepticpedi

    December 15, 2008 at 7:39 pm

  6. Nice article, skepticpedi! I see that Mark Liponis posted almost the same response here as on my blog, http://genefinding.blogspot.com. I replied back to him after looking at all the articles he cites – all of them are very poorly designed studies, as you point out. It seems that Dr. Liponis really believes this stuff – and I have to wonder, is there anything we could say that would convince him to question his beliefs, to be a little bit skeptical? I did the best I could.

    I’ve added you to my blogroll, by the way!

    Steven Salzberg

    December 15, 2008 at 7:49 pm

  7. I appreciate it, and I’ll of coure return the favor. As I said in your comment section I wish I hadn’t read your response to his comment as now I feel like I would just be copying you. I do have some addition things to add but it will be a much shorter post. I’ll link to your comment in regards to the studies.

    skepticpedi

    December 15, 2008 at 8:45 pm

  8. Ah, glad to hear that, skepticpedi! Now I do recall hearing about acupuncture being used to change the fetal position. Of course, often the foetuses (Foeti? Foetodes? I give up) move themselves around, the little rascals, so acupuncture in that case may not be helping at all, naturally… which you know… and I’m babbling… because I need a nap… maybe I’ll just read one more blog entry….

    The Perky Skeptic

    December 17, 2008 at 11:09 am

  9. If you want to stay awake, I suggest something from whale.to. Your anger and frustration should buy at least a few more hours of alertness.

    skepticpedi

    December 17, 2008 at 11:29 am

  10. I must admit, I have not yet had the guts to peruse that site! I’m kind of afraid my brain will spontaneously combust. Then again, maybe I can make a game of it and see how much of it members of my nuclear family believes/has believed in the past…

    The Perky Skeptic

    December 17, 2008 at 11:21 pm


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