Space City Skeptics

The Official Blog of the Houston Skeptic Society

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.

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Written by skepticpedi

December 16, 2008 at 1:30 pm

10 Responses

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  1. Excellent summary, skepticpedi! It’s been interesting to see how Mark Liponis has responded to your comments over on my blog. He seems to be very smooth – not surprising for a “celebrity doc” – and quite familiar with a number of classic strategies, mostly based on logical fallacies, to divert an argument to his own ends.

    For example, Liponis wrote “Many simple things that we take for granted (vaccines, antibiotic use, primary prevention, CPR, cardioversion, surgical procedures, treatment of back pain, cancer treatment and so many other accepted therapies) have just not been studied by good prospective RCTs.” By presenting this list, he’s trying to imply that acupuncture is in the same category as all these other treatments because it shares one feature with them. That’s a false analogy, and furthermore it’s simply wrong to assert that cancer treatments (for example) have not but studied by randomized controlled trials. NCI has 100’s of such trials ongoing right now, and 100’s (maybe 1000’s) have been done in the past.

    By the way, I just visited the Parade website again (5:00pm Tues, 16 Dec) and my comment has re-appeared, along with Liponis’ reply – the same one he posted on my blog.

    Keep up the good work!

    Steven Salzberg

    December 16, 2008 at 4:05 pm

  2. It never ceases to disturb me when these physicians who are not well-trained in science crop up. Seriously, I always thought (until relatively recently) that hard, rigorous science training was a part of pre-med, or med school itself. Then along come the docs who can’t seem to evaluate evidence properly… and those docs talk to the newspapers…

    The Perky Skeptic

    December 17, 2008 at 11:14 am

  3. I don’t know which is worse, that these docs like to talk to the media or that the media listens.

    skepticpedi

    December 17, 2008 at 11:27 am

  4. “It never ceases to disturb me when these physicians who are not well-trained in science crop up.”

    If they went to an allopathic medical school, they definitely were trained in science, but that does not mean they honestly accept and practice it. There are probably many physicians out there who just go through the motions of science to maintain some façade of credibility, yet really are just sticking to their own ideologies. It’s a lot like the science teachers who are mandated to teach evolution, yet they throw in the “goddidit” fallacy to top it off.

    mike D

    December 17, 2008 at 11:45 am

  5. I learned practically nothing about critical thinking and skepticism in medical school. Residency was similarly unhelpful. I had to do the work on my own once I woke up to reality and it is a process which will be forever ongoing if it is to be effective. Doctors, although we use science in what we do, are often not scientists in the way a physicist or someone who has participated in actual research is. One can definitely make it through training not truly understanding how science works.

    skepticpedi

    December 17, 2008 at 12:05 pm

  6. Come to think of it, the only pre-med dude I hung out with on a regular basis was a hopeless case in chem lab! (Biased sample, N=1)

    Skepticpedi, It is really awesome that you took the time and effort to learn the awesome skills of critical thinking!!!

    Mike D, indeed! Dr. Egnor leaps to mind.

    The Perky Skeptic

    December 17, 2008 at 11:14 pm

  7. […] Space City Skeptics […]

  8. My father is a retired research chemist in his 80s, and at his age he sees a lot of doctors. When he meets a new one, the doctor sees the Ph.D after his name and asks what his field was. When Dad replies organic chemistry, they practically start hauling out garlic and crucifixes. One actually said, “My God! When I was in school you were the enemy!”

    This is because the MedSchool organic chemistry requirement is where many doctors’ medical careers almost come to an end. It’s a tough subject if you’re not into chemistry for its own sake, and getting past that requirement is a painful memory for many doctors. Dad knows this well, as when he was a Chemistry grad student he had to try and teach it to a lot of med students.

    Organic chemistry, of course, is the scientific foundation of all medicine. And your typical doctor barely survived it. Tell me again about how well-versed in science doctors ALWAYS are.

    Steve T.

    December 19, 2008 at 1:06 pm

  9. How well one does in college level organic chemistry is an inaccurate indicator of how good a physician a person is likely to be. Personally I struggled to get a C in Organic I and a B in Organic II and the lab. I can honestly tell you that whatever specific knowledge of organic chemistry I have left is not helpful in what I do on a day to day basis and I would argue that holds true for the majority of physicians. I’m not arguing that it isn’t vital to medicine in general, but I don’t have to think about it to make treatment decisions.

    That being said, I agree with you concern regarding how well-versed physicians are in science. But I do not mean the specific knowledge of one particular discipline. Most physicians are not fully versed in the physiology of R rickettsii either but they know how to diagnose and treat Rocky Mount Spotted Fever. The problem is that many doctors are not up to speed on the bare bones of science, and critical thinking, and in particular how that applies to interpreting the medical literature or how it applies to implausible modalities.

    skepticpedi

    December 19, 2008 at 2:52 pm

  10. […] Vote Update on Parade Magazine Article Criticism: Dr. Liponis Responds….. […]


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