Space City Skeptics

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Archive for December 16th, 2008

Update on Parade Magazine Article Criticism: Dr. Liponis Responds…..

with 10 comments

In my last post, I harshly critiqued the recent Parade Magazine article on alternative medicine by Dr. Mark Liponis. I was delighted to find that I was not the only skeptic to tackle the poorly researched claim by Dr. Liponis that acupuncture, biofeedback and meditation “have scientific backing and have passed the litmus test of rigorous medical inquiry.” I enjoyed reading Dr. Steven Salzberg’s post on the subject, which I’ve linked to above.

Both Dr. Salzberg and I received nearly identical responses from Dr. Liponis attempting to rebut the concerns raised in our respective posts. Dr. Salzberg did an excellent job responding, taking each of Dr. Liponis’ points to task seperately. I recommend you read his response as he goes into more detail regarding the specific studies. I want to focus a little more on the errors in logic committed. Here is the comment on my post by Dr. Liponis, with my comments interspersed:

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

Dr. Liponis claimed that three alternative therapies worked as if it were fact. In no way did he come off as if merely stating an opinion. My statements is based on the medical literature, an understanding of which would not lead any reasonable person to believe that acupuncture has, to beat a dead horse, “passed the litmus test of rigorous medical inquiry.”

There is little doubt that a lack of full understanding of a phenomenon does not equate to that something not being true. It would be equally valid for me to state, however, that just because we don’t understand something doesn’t mean that it is true. These are true statements but in the context of attempting to support a claim are nothing but arguments from ignorance. 

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

I’m not clear what Dr. Liponis’ point is exactly. This reaks of a biased author attempting to save face but perhaps it is merely a researcher stating the obvious. No negative study can completely prove that a treatment does not work in all circumstances. But taking into account the extreme implausibility of using toe acupuncture to reposition a malpositioned fetus, a negative study that is better designed and controlled comes pretty close in my opinion. And it raises the question of whether or not precious research dollars should go towards further studies looking into this.

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

Meta-analyses are notorious for their ability to thoroughly misrepresent reality. There is an old saying regarding these unwieldy monstrosities of “Garbage In, Garbage Out”. Taking a large number of small, poorly designed studies and using statistical analysis to attempt to amplify them results in what amounts to one large, poorly designed study. In this case, you have a biased journal of poor quality and a group of studies with bad methodology. But no meta-analysis is more meaningful than one large and well designed RCT. And a comprehensive review of the literature, as are reported in the Cochrane database, tend to be much more accurate as well.

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

And speaking of Cochrane reviews, when I read the conclusion of this one I once again began to doubt whether or not Dr. Liponis actually did any research into these topics that wasn’t effected by confirmation bias. If I weren’t such an damn optimist, I’d swear he was being purposefully deceitful. The conclusion of the review comes across as decidely more reasonable when read as a whole rather than carved up: “There is insufficient evidence to support the use of moxibustion to correct a breech presentation. Moxibustion may be beneficial in reducing the need for ECV, and decreasing the use of ocytocin, however there is a need for well-designed randomised controlled trials to evaluate moxibustion for breech presentation which report on clinically relevant outcomes as well as the safety of the intervention.”

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

Was it published on April 1st? This is yet another study done with poor methodology, no placebo and questionable blinding.

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.

These statements make it abundantly clear where Dr. Liponis is coming from. He is a believer in acupuncture and doesn’t care about what the science shows. When all is said and done,  science is irrelevant unless it supports, or at least appears to as in this case, his stance. I wonder, would Dr. Liponis stop recommending acupuncture at any point based on scientific evidence that it was ineffective. I doubt it.  It is extremely easy for even the brightest of people to be fooled by our inate weakness in interpreting the world around us. Anecdotal evidence is the weakest form of evidence, and notice I didn’t say it was devoid of all value, simply because our brains are so prone to bias. We are at the mercy of entities such as the placebo effect, the desire to please, the thrill of a novel therapy, regression to the mean, errors in logic and sometimes outright fraud. Taking these concerns, and countless others, into account is why scientific medicine has been so successful.

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?”

I do not think it unreasonable for an adult to try acupuncture/moxibustion if they are doing so based on what they perceive to be accurate information. Unfortunately, the public is generally woefully naive when it comes to science and medicine and often depends on sources of information such as the article written by Dr. Liponis. I would think it unreasonable were a patient to seek out any therapy knowing that it has zero prior-plausibility and is not supported by the medical literature.

Written by skepticpedi

December 16, 2008 at 1:30 pm