How Can Magic Be Cost Effective?

How Can Magic Be Cost Effective?

It is amazing how quickly a single study can lead to an analysis as to whether an intervention should be used because it is cost effective.

There is no reason that acupuncture, a complicated magical ritual, should have any specific effect on any pathologic process. However, when I watch videos of acupuncture the process looks quite nice, except, of course, for the whole needles being stuck in the skin with zero attention to infection control. Relaxing in a caring and supportive environment cannot help but make people feel better, as long as they do not get hepatitis B or MRSA.

Like all interventions that do nothing, acupuncture is indicated for virtually everything (except as a form of contraception), at least by their proponents. Depression is on the list of processes that are not effectively treated by acupuncture.

 

After reviewing thirty, count 'em thirty, studies, with 2812 patients, the last Cochrane review

>found insufficient evidence to recommend the use of acupuncture for people with depression.

In 2013 there was yet another study, Acupuncture and Counselling for Depression in Primary Care: A Randomised Controlled Trial that demonstrated that counseling and acupuncture were associated with the same degree of reduction of depression at three months.

With no wait list and no sham acupuncture control there can be zero conclusions made about the whether or not acupuncture per se (as opposed to the magical ritual) was of benefit or whether it was the natural history of the depression in that population.

The authors call it

A pragmatic trial asks whether the intervention works under real-life conditions.

While I would call the trial a waste of time and money, whose methodological flaws proves nothing. Again, isn’t part of the ethical and practical considerations of IRB's to avoid studies that are methodologically garbage? Guess not.

The article states no conflicts of interest, which I am sure is true technically i.e. financially, but when the lead author of a study suggesting magic helps depression is

previously trained as a practitioner of acupuncture and Chinese herbal medicine and subsequently founded the Northern College of Acupuncture

I remember the ever so wise words

Conflicts of interest are very common in biomedical research, and typically they are inadequately and sparsely reported. Prejudice may not necessarily have financial roots. Scientists in a given field may be prejudiced purely because of their belief in a scientific theory or commitment to their own findings.

I will mention as an aside that PLOS does not titles (Lac, ND, MD) in their papers. If a pseudo-medicine is being evaluated it would be nice to know which kind of pseudo-medical provider is doing the evaluation. As the old saying goes "Go to Midas, get a muffler."

So we have a preponderance of literature that demonstrates acupuncture is useless for depression and a fatally flawed study that proposes an efficacy that doesn't exist. What to do next? Not Disneyland.

You are a proponent of acupuncture. You have just finished a methodologically horrible study that you can spin into demonstrating acupuncture is helpful for depression despite a vast contradictory literature. You note that

Acupuncture is rarely provided within the UK’s mental health service or primary care, but private provision of acupuncture for depression is not uncommon.

although what constitutes "not uncommon" from the reference is vague. In a table 7% of providers use acupuncture for "psychological" disorders and the only mention of depression in the text is

Anxiety, stress and depression were the three most prevalent psychological complaints and more commonly treated by independent acupuncturists.

In what looks like a manipulation of PLOS for a marketing program to increase the use of acupuncture in England, most of the same authors of the original paper hired an economist who found that, hey, acupuncture is cost effective.

If I had a conspiratorial bent, I would point to this as proof that the medical literature is being perverted to further the financial gain of Big Pseudo-Medicine.  

But it is not.

Just another sad example of the failure of peer review when applied to pseudo-medicine.

Jesus on toast: chiropractic version
Points of Interest 11/28/2014

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