Sunday, May 30, 2010

Acupuncture Revisited: Idiot Edition

I haven't been blogging lately (sorry, that whole dissertation thing), but I've been moved to anger over this article "Think acupuncture's a hoax? Think again.":

I think what bugs me the most is that the idiot who wrote the article, Elizabeth Armstrong Moore, calls herself "a skeptic". It's like homeopaths calling themselves "practitioners of evidenced-based medicine".

The argument in the article is as follows: some doctors poked mice with needles, and they noticed an upswing in adenosine, and anti-inflammatory, soothing chemical. Therefore acupuncture is not a hoax, it works, and we should all carry around personal acupuncture kits.

You really can't make this shit up. Recall what we learned last time, when we looked at a recent meta-analysis of acupuncture treatments in BMJ:

"A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear."

Moore says that there is a "seeming lack of evidence" that acupuncture works. But the case is stronger than that. We have a seeming presence of evidence that acupuncture does not work. It "seems to lack clinical relevance". "Clinical relevance" means "works".

The problem for acupuncture is NOT that there's no plausible physical mechanism by which it might work. Our real skeptic, Orac, said this: "there are needles breaking the skin in acupuncture. It was, at least to me, not entirely implausible that that might have some sort of physiologic effect." The problem is that EVEN IF there's a plausible physical mechanism by which it works and EVEN IF it does in fact cause an increase in adenosine, we still KNOW that it isn't clinically significant. You can't improve people's health by using it, beyond what you could do by giving people placebos. It may "do something". But doing something is not the same as working. No one doubts that sticking needles into someone does something. But why do it if it doesn't relieve their pain?

Furthermore, the journalist (I don't use scare-quotes, because this is about the level of nonsense I expect from journalists) goes on to say that because mice have elevated adenosine when pricked with needles, we should download "an app, called Qpalm Acupuncture, that maps out acupoints and formulae for treating 59 diseases. and another, iLocate-Acupuncture, for finding acupuncturists near you." That's right, needles can fool the body into thinking it's been damaged. Therefore, it's important to stick needles into those exact places that ancient Chinese pseudoscientists thought were points through which the qi flowed, and acupuncture can *cure diseases*. Aaaaaaaaaaaagh! The stupid.

Skeptic my ass.