More Alternative Medicine in the News…..

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.