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A Letter Received PDF Print E-mail
Swift
Written by Jeff Wagg   

Randi has been hot on the trail of the NIH, most recently in this Swift article. Last week, we received this letter at the JREF.

Dear Mr. Randi, Dr. Plait and Dr. Gorski,

After the recent article at both the JREF and Respectful Insolence regarding cancer and acupuncture, I decided to take a look and see if my employer, Massachusetts General Hospital, had any information on the subject. Sad to say, our cancer center offers acupuncture and ear acupuncture through the HOPES program. And on the page for gynecologic cancers, I found this (bolding added):

Our medical therapies include:

  • Intraperitoneal chemotherapy, a technique for infusing medicine directly into the abdominal cavity, improving survival and reducing side effects for women with advanced ovarian cancer
  • Cancer immunotherapy, which entails vaccinating women with their own modified tumor cells or immune stimulants to bolster the body's response to cancer therapies
  • Innovative therapies for drug resistant tumors that help boost their sensitivity to chemotherapy
  • Acupuncture to help manage side effects

Now, I am quite certain that many patients would gladly fork over money for such things (though I note that acupuncture is offered free through the HOPES program, supported by charitable donations), but that a renowned hospital like Mass General adds yet another bit of woo to its offerings...

The more I learn about this place, the less respect I have. I know that they do some amazing things, provide amazing care to patients and conduct a lot of research, but to have those things tarnished by delving into the mire of CAM (or "Wellness") therapies leaves me feeling a bit dirty by association.

Sincerely,
T
Boston, MA

My mother worked for decades at Mass General, and though she believes it to be one of the finest hospitals in the country, she did have a run-in with the staff when they asked her to learn therapeutic touch. She refused, as it served no place in medicine.  And she was right.

So why do hospitals offer these treatments? Could it be that they're billable, and don't have any side effects (or effects at all), rendering the hospital safe from malpractice suits?

The placebo effect is no excuse for validating treatments long proven to be malarchy. 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. It happens.

Simply put, it's the job of our medical institutions to provide the best, most up-to-date, and most evidence-based medicine possible. In these examples, they are failing to do that.

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written by Arthwollipot, August 10, 2009
Can you be sued for malpractice if the treatment you prescribe for a condition doesn't alleviate that condition?
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written by pakeha, August 10, 2009
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.


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@Arthwollipot
written by Mud Cake, August 10, 2009
written by Arthwollipot, August 10, 2009
Can you be sued for malpractice if the treatment you prescribe for a condition doesn't alleviate that condition?

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 smilies/wink.gif
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written by Firionel, August 10, 2009
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.
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@Firionel
written by Todd W., August 11, 2009
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 science-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:

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.
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Placebo?
written by Michael K Gray, August 11, 2009
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.
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A small correction...
written by Human Person Jr, August 11, 2009
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.
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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.
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written by LovleAnjel, August 11, 2009
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.
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written by thatguywhojuggles, August 11, 2009
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.


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!"
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@LovleAnjel
written by Todd W., August 11, 2009
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.


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.
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Washington D.C.-area skeptics have been battling Suburban Hospital about therapeutic touch
written by garyg, August 11, 2009
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.
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written by Karl_Withakay, August 11, 2009
Can you be sued for malpractice if the treatment you prescribe for a condition doesn't alleviate that condition?


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.
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@Karl_Withakay
written by Todd W., August 11, 2009
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.


Good question. Looks like they charge $55 for a one-hour session. http://www2.massgeneral.org/ca...cupuncture
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@Firionel
written by Todd W., August 11, 2009
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.


The MGH is 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:

relieve symptoms and side effects like insomnia, fatigue, pain, and chemotherapy-related nausea.
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CEO
written by randi, August 11, 2009
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...
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written by RobbieD, August 12, 2009
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??
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Breaking News
written by RobbieD, August 12, 2009
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??
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written by Willy K, August 12, 2009
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. smilies/tongue.gif
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written by Skemono, August 12, 2009
Could any medically trained readers comment on this piece??

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: http://www.nmr.mgh.harvard.edu...I_2009.pdf
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 no 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,
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.

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:
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.

But their findings reveal--yet again--that there was no statistical difference between real and sham acupuncture:
there were no statistically significant differences in pain reduction between TA and SA (p>0.50).


It looks to me like they went fishing for something 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.
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