Comments on: Neil OConnell on A Cup of weak Qi

By: Acupuncture and chronic shoulder pain - CAM or Sham?

Acupuncture and chronic shoulder pain - CAM or Sham? — Mon, 11 Oct 2010 20:41:24 +0000

[...] TweetHaving written a number of posts on acupuncture (see here, here, and here) I guess my particular biases are reasonably apparent. So imagine my surprise when a [...]

By: Neil O'C

Neil O'C — Mon, 15 Feb 2010 11:24:09 +0000

Thanks Ian,

That sounds a fascinating dissertation. I agree with you on all points. The placebo effect is all about the wider meaning on the therapeutic interaction. The technology definitely has a role in developing our understanding of this, the trick is not to overinterpret it. As for your later point I would agree and suggest that the implications are that to maximise your therapeutic effect you need to try to understand the patient and the context of their problem as fully as possible. Of course thats exactly what good pain management strives to do.

By: ian stevens

ian stevens — Sun, 14 Feb 2010 12:08:24 +0000

Neil have you a copy of your shameless self – citation ?!
I did my disseration on meaning/placebo and find the subject fascinating. You may disagree , but to understand ‘meaning’ and clinical effects its interesting to look at the wider cultural beliefs as well as neuroarchitecture displayed in a brain scanner. David Morris writes well in this area . I think people can get seduced by technology myself, although i have to agree that it is fascinating…..Although this is a different subject I think that this discussion (in the link below) is interesting in relation to the fact that the brain is not a single ‘thing’ but is modulated and shaped by community . We deal with individuals but often forget they are embedded in social networks which probably shape beliefs and ultimately motor activity( if this is a focus of ‘treatment’)http://scienceblogs.com/cortex/2010/02/megan_orourke_has_a_really.php
ian
H

By: Neil O'C

Neil O'C — Sat, 13 Feb 2010 09:26:00 +0000

Thanks for your nice comments Bronnie. Moermans writings on placebo are fantastic – all clinicians, researchers and patients should read them. It appears to me sometimes that most acupuncture research is interpreted from the perspective that “we know that it works” and then uncritically reported in the media as such (shameless plug to a related paper I have written with the great Ben’s Wand and Goldacre below). The problem is that the quality evidence would suggest more strongly that “we know that it doesn’t work better than placebo”. This shouldn’t be so surprising given the pre-scientific ideas underpinning it and their inherent lack of biological plausbility.

There is much talk now of “Western Medical Acupuncture” which dispenses with traditional chinese medicine theory and suggests that acupuncture works (mostly for pain) as a kind of novel form of sensory stimulus that alters pain processing. The problem with this is that, as I mentioned in my post, no variation in the sensory stimulus seems to elicit more or less therapeutic effects. Expectations do seem to play a part though (see this lovely paper by Barker Bausell: Bausell RB, Lao L, Bergman S, Lee WL, Berman BM Is acupuncture analgesia an expectancy effect? Preliminary evidence based on participants’ perceived assignments in two placebo-controlled trials. Eval Health Prof. 2005 Mar;28(1):9-26.).

Some acupuncture researchers would suggest that even non-penetrating sham needles are acupuncture too, but I worry that they are changing their own goalposts and making acupuncture an unfalsifiable hypothesis. I guess the bottom line for brain imaging studies that look for things other than the placebo effect to explain how acupuncture works is that it is very difficult if a specific therapeutic effect beyond placebo can’t be found.

Of course thats just my view…

Shameless self-citations:

O’Connell NE, Wand BM, Goldacre B Interpretive bias in acupuncture research?: A case study. Eval Health Prof. 2009 Dec;32(4):393-409.

By: Bronnie Thompson

Bronnie Thompson — Fri, 12 Feb 2010 21:51:18 +0000

Thanks so much for this summary of the association between brain imaging findings and experience. The correlation or causation situation in brain imaging makes it so difficult for uncritical thinkers to unpack, and so often we read headlines like the ones debunked a couple of days ago here! I do like Dan Moerman’s description of the ‘meaning effect’ of health provider interactions, and it doesn’t seem so far-fetched for it to apply to acupuncture (even with effective sham acupuncture methodology).