Another Acupuncture Study Shows It’s a Placebo

Acupuncture is one of the CAM modalities most widely accepted as scientifically proven to be effective, at least for pain and maybe nausea. Even providers skeptical of the mystical roots and language of the practice will often suggest that it might have some real benefit. Unfortunately, the bulk of the good quality clinical research in humans doesn’t support this notion. When compared with “fake” acupuncture (needles placed in non-traditional locations or depths, retractable needles that don’t actually pierce the skin, toothpicks twirled on the skin, and so on), “real” acupuncture generally gets the same results as the fake procedure; namely a small improvement in subjectively reported pain or nausea scores. There’s no question that sticking needles in people (or mice) has measurable effects on the body (releasing various chemicals, effecting pain receptor activity, and so on). This is a long way, however, from demonstrating that sticking needles in particular places and a particular way has meaningful clinical benefits (i.e., that “acupuncture works”).

The debate about the scientific evidence for acupuncture is muddled by the lack of a consistent definition for what acupuncture actually is. Many studies claiming to investigate acupuncture actually use “electroacupuncture” (a CAM pseudonym for what scientific medicine calls TENS, Transcutaneous Electrical Nerve Stimulation). This was the case for a recent set of studies in dogs, and it is also the case for a recent study in humans:

Suarez-Almazor, M., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D., & Street, R. (2010). A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication Arthritis Care & Research

Orac at Respectful Insolence discusses the study in detail. In brief, it compared electroacupuncture with “fake” electroacupuncture (needles in different spots and different amount/duration of electrical stimulation) and with a no-treatment control, and it also compared these treatments between groups of patients given high expectations of success by the providers and those given neutral expectations. The results?

Not surprisingly, there was no difference between “real” and “fake” acupuncture. Both groups reported some improvements compared to the group that got no treatment, which is exactly what you’d expect if the “real” treatment was a placebo just like the “fake” treatment. What is cool about the study is that there were several measures that differed significantly between patients given high expectations and those given neutral expectations, regardless of which treatment they got. Placebo effects are well known to be greater when the fake treatment is presented with confidence by a supposedly knowledgeable professional. In this study the way the treatment was presented to the patients affected how much benefit they got from it and mattered more than which treatment they got, just as one would expect for a placebo therapy.

Of course, real therapies will also appear to be more effective for subjectively reported symptoms if the patient is given high expectations. However, since there was no difference between the effects of “real” and “fake” acupuncture, but there was a difference caused by the expectations the patients were given, the study is a nice illustration of both the fact that acupuncture is a placebo and that expectations are a key element in achieving placebo effects.

This is of particular concern to me as a veterinarian because I believe it is impossible to influence the expectations of my patients about the benefit of the treatments I give them. So unlike humans, they are unlikely to experience any benefit from placebo effects based on expectancy. Unfortunately, their owners are very likely to be influenced by a vet presents a therapy, which leads to a situation in which the client and the vet think the treatment is helping when in fact the patient feels no better. It is this placebo effect by proxy that I think keeps many ineffective CAM therapies alive and profitable in veterinary medicine, especially since the large, well-designed studies necessary to show the underlying reality about the treatments are seldom possible due to cost and practical constraints. We need to take not of such studies done in humans and recognize the implications they may or may not have for our field given the differences between humans and our patients.

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13 Responses to Another Acupuncture Study Shows It’s a Placebo

  1. Bartimaeus says:

    I wonder if the recent studies of electroacupuncture in both the human and veterinary medical literature indicate some desperation on the part of acupuncture researchers? There seems to be a common thread in several of these studies-they use electroacupuncture without any comparison or even mention of TENS, and claim that the results support the use of acupuncture despite the fact that electroacupuncture is not really that similar to the claims made in support of “traditional” or “neuroanatomic” acupuncture, which do not require the application of electricity for their claimed effects.

    It may just be wishful thinking on my part, but this seems to be a weakening of the position of the proponents of acupuncture.

  2. Wish on if you want. I think the new CAM position will be……. Acupuncture works so well they are even doing electroacupunture studies now.
    art malernee dvm
    fla lic 1820

  3. Bartimaeus says:

    I’m sure that is what the true believers will say, but these studies of electroacupuncture still seem particularly weak to me, and I hope to others as well.
    I think we are seeing the goalposts shifting before our eyes, and while I am sure that this kind of thing can go on indefinitely, it might indicate that previous arguments in support of acupuncture look weak even to those who made them. It gives us some more evidence to use, but I don’t think (and did not say) that the proponents of acupuncture are going to disappear anytime soon.

  4. I noticed someone from vet school posted this on quackwatch this week. Take a look at the goal shifting video about the new scientific acupunture.

    http://www.csuvets.colostate.edu/pain
    http://www.science-of-acupuncture.com
    http://www.askdrnarda.com

    art malernee dvm
    fla lic 1820

  5. skeptvet says:

    Yes, Dr. Robinson is a bit of a puzzle. Solidly advocating for evidence-based medicine when it comes to some methods (such as homeopathy), yet aggressively promoting acupuncture depsite the overwhelming evidence it is a placebo, and reluctant to criticize things like Reiki which are at least as ridiculous as homeopathy. I’ve asked her to send me the evidence for veterinary acupuncture she finds so compelling, but she hasn’t done so yet, and I don’t have the time or money to take the CSU course just to get a chance to evaluate her claims.

  6. Bartimaeus says:

    In addition to the expense, the structure of the course (four one-week sessions a month apart) makes it difficult to do unless you live relatively close. The travel expenses and time off would add up to a big investment if you were going to take the course merely for professional/skeptical interest (I have thought of taking it as well). I wonder if the course is structured that way intentionally? The Chi Institute course is structured in a similar way, but with a heavy emphasis on TCM and no obvious claims of scientific validation. Both programs are supported by their state boards however. Perhaps an inquiry to the state CE committee or whomever decides what gets accredited in Colorado and Florida would be in order. It may be that Dr. Robinson is involved in those decisions in Colorado however, and acupuncture is enshrined in the practice acts of several other states including Arizona.

  7. Perhaps an inquiry to the state CE committee or whomever decides what gets accredited in Colorado and Florida would be in order. >>>>

    The Florida veterinary board currently does not even measure hours of required by law CE even when it is required by law to do so. The Florida Vet Board meetings start around 8am never last past noon. The vets attending the board meeting get their last two certified CE hours of credit for attending the meeting in the liquor bars at the hotel where the veterinary board meeting is held. I have read the Texas vet board now measure at least a time measurement at required by law CE meetings. Anyone know the name of the vet who got texas to do that? Was it Bob Rogers? I hate to lie and say I got tooth fairy hours of CE just to keep my licence. I checked with the state of Florida and have written documentation that Florida law really does require CE meeting to be measured in hours.

  8. v.t. says:

    skeptvet, Robinson has been challenged on this issue several times, her reaction is to always point to: the footnotes in her articles, her website, her “upcoming” articles (as if new information is always forthcoming to prove her claims). When you still don’t get satisfactory results, you are accused of “wasting her time”.

    The fact she even promotes reiki at all and can’t bother to debate beyond her own wishy washy belief system does not lend credence to her position at CSU. Seems her course fees are funding her agenda.

  9. Bartimaeus says:

    You are right v.t. the evidence Robinson cites in support of acupuncture seems to be limited to footnotes, etc. Most of her writing seems to be for Veterinary Practice News, and I have had difficulty finding any peer-reviewed work. This evidence also seems to be limited to information about the effect on the nervous system (changes in nerve activity, neurotransmitters, etc) when a needle is inserted, and I have not seen any studies showing any real clinical effectiveness at all. I suspect the course fees are an important motivator for CSU to keep the whole charade going.

  10. Anyone know what would happen if as a DO she was teaching Physicians these courses at medical schools, treating children rather than animals, and promoting the course online on the state medical associations websites?

    I know the courts would not allow the physicians to keep chiropractors out of their offices. What about keeping them out of medical schools?

    art malernee dvm
    fla lic 1820

  11. JJ says:

    I have been brutally devastated by lithotrypsey surgery for kidney stones since 2000 until I went to an acupuncture clinic last week knowing I had a 10 millimeter kidney stone that has been un-operable since last year 2009. Three notable urologists said I had to take pain killers (oxycodone) since last year because the stone was in the lower left part of the left kidney behind the transverse colon and was inoperable. The licensed acupuncturist put a few small needles in my back, arm, and legs. I never felt a thing. They suggested that I take some herbs that I made out of a tea and jump rope. I found myself in the ER the next day as 10 millimeter stone had broken into several 3mm pieces, and they were passing quickly. The ER nurse used one needle and ruptured two major blood vessels in my right arm causing major discoloration and swelling while my urologist called in narcotic meds from the 7th hole at the country club. They pumped my ruptured veins with morphene and zofran and sent me home and said to go schedule a surgery when the MD gets back from playing GOLF. Instead, I waited a couple of days, I was unsure of what to do. Three days later I was still having pain from the stones so I boiled some more of the herbal tea which consisted of 12 packets of herbs. To my surprise, two hours later, I peed out all the stones with little or no pain. I must say that I have never totally recovered from lithotrypsy in 2000 or in 2008. I developed diabetes shortly after my first lithotrypsy and have never been able to really exercise without pain in the kidney area after the surgery. I wish I had known that there was a simple natural way to pass my kidney stones. The old 70 year old urologist told me I was crazy for believing that acupuncture helped my stone. I think he is crazy for thinking I would have let him make another 15 grand off of a surgery that caused me more pain and suffering than I had ever experienced. I wish someone would have told me that I could have just bought a 12 dollar bag of herbs. They don’t taste so great, but hey, it beats the heck out of feeling like the mob got a hold of your kidney with a bat. Or should I say the rich Mob Doctor MD.
    J

  12. skeptvet says:

    J,

    All of this is understandably compelling for you. Sadly, it proves nothing about acupuncture or any other medical approach. If acupuncture could so easily cure bladder stones, why did people continue to suffer from this problem in China for thousands of years despite the use of this treatment? The reality is that when one thing happens and another thing follows it, it isn’t always true that the first thing caused the second. Sur,e it makes, sense, only it isn’t true.

    I’m happy things worked out for you, but I also know for certain that if people take this story to mean what you think it means, that acupucnture and herbs is an appropriate way to treat bladder stones, lots of people will suffer needlessly for putting their faith in an ineffective treatment and avoiding treatments that can work.

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