Wednesday, March 25, 2009

Needles for needles? (Response to Orac comments)

I don't know when this Orac fellow sleeps, but he is not only a research scientist and surgeon but also writes a well-researched blog on medicine/biology. Recently he wrote a post criticizing a Baltimore prison program sponsoring acupuncture as a drug addiction therapy for inmates, saying it's a waste of $40,000 since acupuncture has been discredited as an addiction therapy in most studies.

Here is what I commented:
An interesting post. I agree in some ways, disagree in others. Have you ever tried acupuncture, Orac? Some people swear by it.

I doubt acupuncture will have much of an effect on drug addiction, we agree there. But then what does? There is no cure for addiction, just like there's no magic bullet for cancer. We spend plenty more than $40,000 treating addiction with all kinds of therapies that might also not work. We also spend trillions making wars that don't make any sense. Are you as critical of those programs as you are of this one?

As a research scientist, I think it's not a terrible idea to try some "high risk" therapies - ones that might not work, but if they do there's a big payoff.
I got a lot of responses. I will reply to a few of these here so my readers can benefit from the discussion.

oh sigh... There is a reason that randomized double-blind studies are used to determine the efficacy of therapies – personal experience is unreliable.
Although double-blind studies are perhaps our most rigorous test of therapies, they are not infallible. They provide no mechanism and often use small sample sizes. Human society is very diverse and it's difficult to control for different variables.

Personal experience is subjective, certainly, but
it is still data. It's a valuable way of gaining insight into what is actually going on. I wouldn't be so quick to dismiss it. In fact, I'll bet most doctors use "personal experience" as their #1 diagnostic tool.
Please don’t tell us that your woo therapy worked because you felt better just after you were treated, unless you can explain why the improvement you experienced could not possibly be due to one of the following:

1. Placebo
2. Temporary mood improvements due to the personal nature of the treatment
3. Psychological investment of the patient in the success of the therapy...

I agree with your idea that we should try some high risk therapies. Its just that acupuncture is not one of them. Not only is it not an unknown, its been tested and tested for 30 years, and after initial confusion with placebo, its pretty damn clear that there is nothing else to support it.

First off, there was that Yale study that Orac mentioned in his post that suggested that acupuncture helps with cocaine addiction.

Second off, so what if it is placebo? We're talking about
inmate drug addiction here. Even if it works by providing the inmates a little personal contact and love - shouldn't we take advantage of that? Maybe placebos work.
As for being critical of other things, like non-sequitur. Superman could come here and wipe out everyone in the state of Virginia and if Orac didn't bother to comment on that, it still wouldn't make acupuncture any more effective or useful.
The question is about our priorities in spending public funds. How can you talk about the ants if you ignore the elephant in the room? (sigh)
It's funny, I think a lot of Orac's previous acupuncture posts start with the mention that once upon a time, he thought there might be something to the whole 'acupuncture thing'. Not the business with energy flow and meridians, but that there might be some science behind 'being poked with needles makes one's head hurt less'.

Then he did some reading on it, looked at studies that compared acupuncture with being poked with non-needles in the wrong places, and noticed that they show the exact same result. That's a very good sign that the needles aren't doing much, and it's mostly in the heads of the people being poked (maybe not consciously in there, but in there).

Hey, a few years ago I'd have been totally dismissive of acupuncture. But after 6 years in California, well... there's something in the water out here :) 

FYI, acupuncture and Chinese medical treatments are covered in your health insurance out here. They are practiced by licensed professionals. One of my housemates just passed her boards, she works side-by-side with a very successful MD.

As for the therapy being "mostly in the heads of the people being poked" -- see my reply to TechSkeptic above.
I tried acupuncture when I was a believer in such things. I swore it up and down that it worked. It had to, it was expensive. Once I had awakened to what a gullible slave to woo I had become, I saw that acupuncture was really not any more effective than a good nap... The same was true for bodywork, reiki, and other assorted woo I used to swear by. Now I just go lie down or talk to someone I love or pet the dog or, well, you get the picture. Science works. Woo is wishful thinking.
I loved your story. This personal experience may be subjective, but it's still data.

I think some of these inmates might not have a dog to pet, or a loved one to talk to. Acupuncture may be beneficial for their health, possibly to help them relax, possibly as a placebo. I don't think it will cure their drug addiction. But who knows, maybe it couldn't hurt.

That's all the comments I feel like replying to right now. I got work to do. Science, y'know.

1 comment:

Techskeptic said...

Personal experience is not data. You have allowed the same thing that created the mercury militia to come about to cloud your science.

Without controls the best and only thing personal experience is good for is to notice a possible correlation. That is it. You can have thousands of people think the same thing, have personal experiences and unless it is controlled, it is meaningless. We currently have this exact condition with anti-vaxers, homeopaths, and practitioners of every form of woo there is.

They each have many anecdotes of how someone got better, without examining if it had anything at all to do with the treatment they were giving.

As a human, you and I are prone to lots and lots of subjective thinking and biases, we can not help it. We fall for fallacies, we accept information without questioning assumptions. we are human and cant help it. Even when we know about placebo, we improve form placebo effects. That is why anecdotes are useless, they provide no information that allows us to pull our what is real and what is the result biases and cognitive assumptions based on decades of personal experiences, failures and successes.

This is exactly how bloodletting as a medical procedure was allowed to become so prolific for so long. Are you also for blootletting? The only reason it fell by the wayside was because people started indirectly looking at its efficacy against not using it, while trying to make all other conditions the same. i.e. creating controls

A small double blind study is far far more valuable then thousands of anecdotes. They are useless.

Just because CA insurance covers acupuncture says nothing of its efficacy, it says everything about how those dollars are being spent. too bad for the people who pay that insurance.

The good part of evidence based medicine is that it also has placebo, each and every treatment, pill, and procedure has some element of placebo in it. It doesnt get rid of placebo, it surpasses it in performance. That is why they test against it.

Placebo, when not used as a control is in fact dangerous and costly. Its also deceitful.