An Acupuncturist's Plea: Let Us Keep Fooling Ourselves

An Acupuncturist's Plea:  Let Us Keep Fooling Ourselves

I first ran across Betteridge's law of headlines earlier this week, which states

"Any headline that ends in a question mark can be answered by the word no."

Then I ran across the article

Complementary and alternative medical treatments: can they really be evaluated by randomised controlled trials?

The authors answer is, not unsurprisingly, no:

However, many aspects of RCTs are incompatible with the 'proper' practice of CAM. Pragmatic trial data could be utilised more by commissioning bodies when evaluating CAM modalities, such as acupuncture, in order to better compare clinical effectiveness and cost-effectiveness.

Why is that?

the context in which a CAM treatment is provided is arguably an intrinsic part of how effective that treatment is…These integral subjectivities, otherwise considered 'biases' in RCTs, are believed to be an important part of effective practice. Limiting these factors distorts the validity of results, and attempting to measure an isolated 'active ingredient' may detract from the overall efficacy.

In other words, all the potential for bias should be allowed to be remain in the evaluation of CAM because that is how CAM works.  Interesting admission.

From N-Rays to mammary artery ligation to knee surgery, practitioners and patients have been fooled by a variety of biases that have led them into thinking that something is happening when, in fact, nothing is. This author evidently prefers to keep it that way.

Blinding poses a problem for CAM treatments such as acupuncture—how can one blind a technical procedure?

Quite easily actually. The problem is not that sham acupuncture is difficult, it is that when there is a legitimate sham 'real acupuncture' does no better aka acupuncture does not work.

In Chinese medicine, de qi, which can be perceived by both patient and practitioner, is believed to generate synchronicity between the two parties. Only when both patient and practitioner are aware of the attainment of de qi is the therapy considered to be complete.

It is also clear that acupuncture only 'works' when the patient believes they are getting acupuncture and they anticipate a positive outcome. So when both have the attainment of de qi, both are have been primed to believe that acupuncture will have an effect.

In the context of maximizing the placebo effect

patient engagement is arguably more critical for efficacy in CAM.

Further suggesting that CAM is no more than an immoral psychological manipulation with no real physiological effects.  Which, as we have argued for years, it is.

So instead of doing studies that help determine if acupuncture studies is effective, he suggests instead continuing the kind of studies that only confirm the pre-existing bias that acupuncture is effective:

Greater utilisation of pragmatic trials, which take into account overall effectiveness and can also be used to assess cost-effectiveness, could help medical decision-making.

This paper is essentially suggestion that when studying acupuncture and CAM, that Why Most Published Research Findings Are False be used as a how-to rather than as a warning of methodologies to avoid.

despite the growing body of evidence to support wider use of CAM treatment, RCT data are still inconclusive in many areas.

That's the problem: the growing body, which has been growing for decades, is negative when true rigor is applied to their evaluation.  Which is what you would expect from an intervention that is grounded in the fictions of qi, meridians, and di qi.

It must be difficult to be an acupuncturist. It doesn't matter which of the multitudinous forms of acupuncture are used, that acupuncture is no better than sham acupuncture (i.e. not effective) and the same effects can occur if toothpicks are twirled, if acupuncture is mimed or if acupuncture is performed on a rubber hand. It is the ultimate theatrical placebo and to admit that your entire professional career is a fiction is more than most can do.

Richard P. Feynman said "The first principle is that you must not fool yourself and you are the easiest person to fool."

CAM researchers prefer to continue to fool themselves and others. Less cognitive dissonance that way.

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