Comments for A Letter Received at http://www.randi.org/site , comment 1 to 20 out of 20 comments http://www.randi.org/site Thu, 23 May 2013 09:25:02 +0100 FeedCreator 1.7.3 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9484 [quote]Could any medically trained readers comment on this piece??[/quote] I'm not medically-trained (sorry), but I'll try commenting on it anyways. I found what I believe is a PDF of the full study on-line. So anyone who wants to read it can do so here: [url]http://www.nmr.mgh.harvard.edu/~vitaly/PDF/Harris_AcuMOR_NI_2009.pdf[/url] I read it, though I won't pretend I understood a lot of it. But a few things stood out: (1) They only had 20 participants in the study. That seems very small, I don't know how well they can derive solid conclusions from that. (2) They say they were comparing traditional Chinese acupuncture to sham acupuncture. So they randomly assigned 10 of the ladies to each group, and blind-folded them during the acupuncture so they wouldn't notice which one they got. They even asked the participants afterward which group they thought they were in. So clearly this was single-blinded... but I don't see anything indicating it was double-blind. Did the researchers know what group each lady was in? If so, then observer and researcher bias might come into play. (3) The biggest thing that stood out to me is that the researchers admit that studies have shown [i]no[/i] difference in pain reduction between "real" acupuncture and "sham" acupuncture, but the researchers decided to do a study that questions what the difference is. They say in the introduction, [quote]it was hypothesized that long-term acupuncture therapy may result in increased MOR BP, or receptor availability in vivo. Further, we reasoned that these effects would not be observed in the sham treatment group, thus differentiating “placebo” from active treatment conditions.[/quote] I really don't understand how they can admit there's no difference but go searching for one anyways. (4) The introduction also says that they expect a decrease in pain in "real" acupuncture: [quote]Finally, since regional decreases in MOR BP have been associated with greater clinical pain in FM patients (Harris et al., 2007), increases in BP were expected to be associated with reduced clinical pain.[/quote] But their findings reveal--yet again--that there was no statistical difference between real and sham acupuncture: [quote]there were no statistically significant differences in pain reduction between TA and SA ([i]p[/i]>0.50).[/quote] It looks to me like they went fishing for [i]something[/i] that would make acupuncture "real", but ended up once again showing that there's no difference between real and fake acupuncture. But someone else may have a different take on it. You might want to ask Orac at Respectful Insolence to weigh in on this study, or the people at Science-Based Medicine. - Skemono Wed, 12 Aug 2009 17:27:17 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9480 About twenty years ago I hurt myself ice skating and went to the local hospital emergency room to make sure my injury wasn't serious, it wasn't. The admitting nurse asked what was my religion, she was shocked when I said "none." About thirty years ago I had my tonsils out, a priest came and "blessed" me before the operation. I didn't say anything but it was a very uncomfortable experience. If hospitals allow the big woo of religion, it is only a matter of degree when they allow medical woo too. :P - Willy K Wed, 12 Aug 2009 14:30:43 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9452 See http://www.sciencedaily.com/releases/2009/08/090810104935.htm for a report that may indicate an effect for acupuncture - or perhaps it is more to do with the psychology of chronic pain. Could any medically trained readers comment on this piece?? - RobbieD Wed, 12 Aug 2009 03:54:16 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9450 It seems that many doctors these days are quite happy to invoke the placebo effect if the patient 'feels better' as a result, even though it is fundamentally dishonest. This willingness on the part of the medical profession to lie to its patients may not be entirely new, but it seems more prevalent these days and has fuelled the rise of 'alternative' non-treatments. Can any readers in the medical profession clarify the ethics of a doctor lying to his/her patient?? - RobbieD Wed, 12 Aug 2009 03:05:02 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9438 The observation "there's much worse out there" reminds me of those who say that rape should not be prosecuted because murder is more serious... The reason I'm fighting endorsement, teaching, and acceptance of acupuncture by prominent medical authorities is that such association provides validation of the quackery. And, "feeling better" is not acceptable if "getting better" has been bypassed... - randi Tue, 11 Aug 2009 09:49:17 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9437 [quote]I am in no way supporting the use of accupuncture (or anything comparable to it) as a therapy. And interestingly, I don't think any of the institutions under attack here really did.[/quote] The MGH [i]is[/i] offering acupuncture as a therapy. Take a look at that list again. It is listed as a "therapy" in the same list as chemo. Further, while they are not offering it as a treatment for cancer itself, they are offering it as treatment for the side effects of chemo/radiation. From the site I linked to above, acupuncture (and massage) is offered to: [quote]relieve symptoms and side effects like insomnia, fatigue, pain, and chemotherapy-related nausea.[/quote] - Todd W. Tue, 11 Aug 2009 05:02:24 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9436 [quote]The real question is, can you be sued if you provide (and charge for) treatment/therapy that you know is ineffective? I don't know if that qualifies as malpractice, but I believe it does qualifies as fraud.[/quote] Good question. Looks like they charge $55 for a one-hour session. http://www2.massgeneral.org/cancer/resources/support/hopes.asp#acupuncture - Todd W. Tue, 11 Aug 2009 04:58:01 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9435 [quote]Can you be sued for malpractice if the treatment you prescribe for a condition doesn't alleviate that condition? [/quote] The real question is, can you be sued if you provide (and charge for) treatment/therapy that you know is ineffective? I don't know if that qualifies as malpractice, but I believe it does qualifies as fraud. - Karl_Withakay Tue, 11 Aug 2009 04:51:05 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9434 But to my knowledge have not received a response. It's scary that one writer's mother had a "run-in" with the staff for refusing to learn TT. This raises the prospect of being disciplined for holding to your belief in science and rationality. - garyg Tue, 11 Aug 2009 04:44:13 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9433 [quote]it came with a free round of cupping, unasked for and not cleared with the patient first. My friend told me that they just started putting the cups on his back without saying anything. He said it was extremely painful and his back was covered in burns afterwards.[/quote] Sounds like grounds for a charge of battery. I'm surprised that they would open themselves up to liability like that without some written consent. - Todd W. Tue, 11 Aug 2009 03:57:44 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9432 [quote]written by Firionel, August 11, 2009 To clarify: I am in no way supporting the use of accupuncture (or anything comparable to it) as a therapy. And interestingly, I don't think any of the institutions under attack here really did. They are toeing the line, and presumably intentionally so, but they are not really trying to supplant other forms of treatment. Therefore I cannot help but wonder whether our attention might not be of (much) greater use elsewhere, where real charlatans are peddling fake therapies, not simply institutions trying to reduce their workload by catering to the preconceived ideas of their patients. I know, you all think they shouldn't. And indeed they shouldn't. But this world is far from ideal, and I really think there's much worse out there. [/quote] The problem is, that by letting Hospitals provide quackery, they give the Quacks out there more credit. "If the big hospitals are using it, it must be okay!" - thatguywhojuggles Tue, 11 Aug 2009 03:54:37 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9431 I'm pretty much against any woo being offered at a hospital. Not only does it lend legitimacy to acupuncture, but the practitioners do not necessarily stop with the needles. My friend got some free acupuncture for his back at the hospital (they had been doing injections and all sorts of real medicine that wasn't helping the pain very much), and it came with a free round of cupping, unasked for and not cleared with the patient first. My friend told me that they just started putting the cups on his back without saying anything. He said it was extremely painful and his back was covered in burns afterwards. Doctors are limited by malpractice insurance. Woomeisters are not. - LovleAnjel Tue, 11 Aug 2009 03:27:29 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9430 To clarify: I am in no way supporting the use of accupuncture (or anything comparable to it) as a [i]therapy[/i]. And interestingly, I don't think any of the institutions under attack here really did. They are toeing the line, and presumably intentionally so, but they are not really trying to supplant other forms of treatment. Therefore I cannot help but wonder whether our attention might not be of (much) greater use elsewhere, where real charlatans are peddling fake therapies, not simply institutions trying to reduce their workload by catering to the preconceived ideas of their patients. I know, you all think they shouldn't. And indeed they shouldn't. But this world is far from ideal, and I [i]really[/i] think there's much worse out there. - Firionel Tue, 11 Aug 2009 02:16:03 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9429 The word you're looking for is "malarkey." However, I'd like to borrow your word, "malarchy," to describe government (archy) by a ruling class of evil (mal) individuals. - Human Person Jr Tue, 11 Aug 2009 02:12:11 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9428 I wonder if the palliative effects of good "bedside manner" falls into the placebo category? At least it need not involve outright lying** to the patient, unlike the criminally fraudulent non-therapies such as therapeutic touch, rieki, Homœpathy, etc. ____________ ** Even if by way of studied willful ignorance on behalf of the untutored huckster. - Michael K Gray Tue, 11 Aug 2009 01:32:12 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9427 Take a look at http://whatstheharm.net/acupuncture.html to see some of the impact that it can have. Granted, the info there is anecdotal, but I guess those anecdotes cancel out acupuncture's anecdotes. Hospitals should be offering [i]science[/i]-based medicine. Once you get into alternative (read, placebo) treatments like acupuncture, you start to bump into ethical issues: lying to your patient, lending legitimacy to something that doesn't actually work, billing insurance companies (and possibly Medicare/Medicaid) for a service that has no real effect beyond placebo, and so on. As Jeff mentioned: [quote]A patient "helped" by accupuncture for pain during recovery from a sprained ankle, may then look to other "ancient wisdoms" to cure his heart ailment.[/quote] - Todd W. Tue, 11 Aug 2009 00:55:46 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9425 I am still a little confused by the recent obsession with accupuncture. Really it is quite clear that it can do little (if any) damage of itself, and in none of the examples presented here I would say that somebody was suggesting to treat the actual cause of a medical condition by accupuncture. In fact, in this case it quite clearly says "to help manage side effects". The point is: If medical clowning can help manage side effects why shouldn't accupuncture? Of course it's not an effective therapy, but it makes (some, quite possibly less scientific) people feel better. That's what counts. - Firionel Mon, 10 Aug 2009 23:57:08 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9424 written by Arthwollipot, August 10, 2009 [quote]Can you be sued for malpractice if the treatment you prescribe for a condition doesn't alleviate that condition? [/quote] One should hope not. There are many treatments and medicines that aren't effective for all patients. Doctors need time to find out which treatment works for which patient. If they get sued for prescribing something that happens not to work for one patient, even when it generally works for half of the patients, then that would just make their job impossible. However, there is a good case for malpractice if there isn't any evidence it works for any patient. Perhaps that's what you meant, if so forget I said anything ;) - Mud Cake Mon, 10 Aug 2009 22:01:54 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9423 An interesting letter. I hope there will be many more like it, obliging medical practitioners and institutions to examine dispassionately those treatments which, far from being harmless gestures to improve a patient's comfort by invoking the placebo factor, can be pernicious if not deadly. - pakeha Mon, 10 Aug 2009 21:06:50 +0100 http://www.randi.org/site/index.php/swift-blog/668-a-letter-received.html#comment-9422 Can you be sued for malpractice if the treatment you prescribe for a condition doesn't alleviate that condition? - Arthwollipot Mon, 10 Aug 2009 21:00:26 +0100