Does it work? Depends on whether the endpoint is subjective or objective.

Does it work? Depends on whether the endpoint is subjective or objective.

Do pseudo-medicines work? It all depends on what 'work' means.

Do they affect underlying physiologic processes lead to symptoms? Virtually never. Most of the pseudo-medicines discussed on this website are at best implausible verging on the impossible. There is no reason to suspect that acupuncture or chiropractic or reiki or homeopathy would have any effect upon any disease pathophysiology.

But having interactions with providers can have effects on subjective complaints. It is probably no different from the calming effect grooming has on apes. But as a rule all the effects of pseudo-medicine are on subjective problems, the placebo response.

A recent example can be found in Effectiveness of Ayurvedic Massage (Sahacharadi Taila) in Patients with Chronic Low Back Pain: A Randomized Controlled Trial.

Patients with chronic low back pain were randomized to Ayurvedic massage or heat. With no blinding or sham intervention there is no way to know if there is a specific and unique advantage to Ayurvedic massage. The potential for bias is tremendous and no conclusions can be drawn for efficacy. But it is interesting to note that

While beneficial effects on pain-related bothersomeness and psychological well-being were also apparent, the Ayurvedic intervention did not improve function or disability in the short-term observation period.

Subjectively the patients felt better but function did not improve, suggesting the results are due to the beer goggle effect that is alternative medicine. It is this nonspecific effect that makes it critical to have both blinding and a sham/placebo group to determine if a pseudo-medicine is effective.

Sometimes it is argued by pseudo-medical providers that their particular intervention cannot be tested with a sham procedure. Chiropractors in particular make this argument. You can't do sham chiropractic, although I would suggest they all do.

But you can. In a study looking at the efficacy of CMT for migraine

The placebo group received sham manipulation, a broad non-specific contact, low-velocity, low-amplitude sham push manoeuvre in a non-intentional and non-therapeutic directional line of the lateral edge of the scapula and/or the gluteal region . All of the non-therapeutic contacts were performed outside the spinal column with adequate joint slack and without soft tissue pre-tension so that no joint cavitations occurred.

and the results?

Migraine days were significantly reduced within all groups from baseline to post-treatment (P < 0.001). The effect continued in the CSMT and the placebo groups at 3, 6 and 12 months follow-up, whereas migraine days reverted to baseline level in the control group

and these were in patients who thought they had the real deal.

80% of the participants believed they had received CSMT regardless of group allocation

Of note the CMT group also had more adverse events.

So in a successfully blinded chiropractic study, CMT was equal to sham with more complications. When CMT  improves subjective complaints like headache it is because nonspecific placebo effects.

The only conclusion to be drawn from this study is that CMT does not work for the treatment of migraines. If a medication is no better than placebo and has more side effects, we say the medication does not work and should not used as all if offers is side effects. Not in the world of pseudo-medicine.

Because some migraineurs do not tolerate medication because of AEs or co-morbid disorders, CSMT might be considered in situations where other therapeutic options are ineffective or poorly tolerated.

Same as it ever was.

Points of Interest 10/07/2016
Points of Interest 10/06/2016

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