The Rogues Gallery

Acupuncture – The Cat Came Back

Poorly conducted acupuncture studies are like the cat that just won’t stay away. They just keep pouring in, coming back in new shapes and forms. Traditional acupuncture is a very extraordinary claim. That our bodies have meridian points through which our life energy, or Qi, flows. According to practitioners of acupuncture, the life energy can be accessed and manipulated through the insertion of needles at the meridian points. And by this method, symptoms and diseases can be treated and even cured.

Quite an extraordinary claim. And recently many studies have concluded that acupuncture is a viable compliment or alternative to modern medicine in some form. There was the study that showed that acupuncture can increase the chance of conceiving through IVF. The Rogues discussed this in Episode 134 of the SGU and Dr. David Gorski wrote about it on Science-Based Medicine. There was the study that concluded that acupuncture can help with heartburn. Dr. Harriet Hall covered that one on Science-Based Medicine. Both studies have been shown to be inadequate sources of evidence for the claims they are making. In other words, the extraordinary claim was not backed by extraordinary evidence.

Well the cat came back, so to speak. A new study shows that acupuncture can be effective against menstrual pain. The study, published in the February 2008 issue American Journal of Obstetrics & Gynecology, concludes that

“Additional acupuncture in patients with dysmenorrhea was associated with improvements in pain and quality of life as compared to treatment with usual care alone and was cost-effective within usual thresholds.”

In other words, this study concludes that acupuncture can help relieve menstrual pain, or dysmenorrhea. In fact, based on the findings of the study, the researchers state:

“Acupuncture should be considered as a viable option in the management of these patients.”

So let’s look at the study. The study was done with 201 women who were assigned either acupuncture or no treatment. It lasted 3 months and included an average of 10 sessions per subject. The subjects used a pain scale that ranged from 1 to 10, 1 being no pain, 10 being unbearable pain. For the acupuncture group, the average score was 3.1 and in the no treatment group, the average score was 5.4. 63.4% of the women in the acupuncture group reported a 33% or greater improvement in their symptoms, while only 24% in the no-treatment group reported similar effects.

So here are the problems that I see with this study. First of all there is no placebo control group. The subjects either received acupuncture, or they did not. There was no attempt to single-blind the study, let alone double-blind it. So the placebo effect, or trial effect, probably had a role in the results. Dr. Novella wrote about this on Neurologica Blog:

“Rather than a placebo effect, there is, rather, a trial effect – namely the fact that a patient is enrolled in a clinical trial will improve their outcome. This is due to a host of factors – being in a trial means getting more medical care and attention, and it inspires patients to think more about their care and thereby to take better care of themselves, for example by being more compliant with their treatments. “

To partially correct this, a third group of subjects could have been used who were given a form of “fake” acupuncture. Perhaps needles being randomly inserted, or no needle at all, just the appearance or feeling of them being inserted.

The second problem is the symptom being investigated. Pain is a very subjective symptom. Similar painful experiences can be reported very differently between individuals. For example, on the pain scale of 1 to 10, I would rate blood drawing from the arm an average of 2, however my wife gives it an average of 4. Same procedure, same area of the body, same needle gauge, but two different ratings on the pain scale. The only data gathered in this study seems to have been pain scale ratings of each subject. Which can vary greatly between individuals, regardless of other factors.

I’m on the fence when it comes to clinical studies of so-called alternative medicine. On one hand, I’m in favor if the study monitors objective, measurable data. And if the study is properly randomized, double-blinded, and placebo-controlled. However, I find it hard to be accepting of spending time and money on studying a process who’s basic principles violate what we already know to be true. Homeopathy’s “Law of Infinitesimals” for example.

After reading the manner in which this study was conducted, and the data which it gathered, I do not accept the conclusion of the researchers as fact. As Carl Sagan famously said, and as I alluded to earlier in this post, “extraordinary claims require extraordinary evidence.” This evidence is far from extraordinary.