Feb 02 2012

American Headache Society Recommends Placebos for Migraine

This is yet another installment in my series on how so-called “alternative” medicine thrives under a double standard – a bizarro world where the rules of science and logic are suspended in favor of uncritical promotion. The American Headache Society (AHS) just sent out a press release endorsing acupuncture for migraine headaches. They write:

Mt. Royal, NJ (February 1, 2012) – When it comes to treating migraine, so-called “sham” acupuncture (where needles are inserted only to a superficial depth in the skin and not in specific sites) and traditional acupuncture where needles are inserted in specific sites, both are effective, according to the American Headache Society (AHS).

Citing publicity surrounding a recent Canadian study comparing the effectiveness of the two types of acupuncture, David W. Dodick, MD, AHS president, said both types of acupuncture, particularly when electrical stimulation is involved, may work to release endorphins that are important in controlling signals of pain and inflammation.

“How much of a benefit sham acupuncture can have on the release of these chemicals is unclear,” he said. “This suggests the benefits of treatment may not depend on the exact technique of acupuncture and needle positioning.”

Studies show that sham acupuncture is as effective as true acupuncture, and Dr. Dodick concludes from this that both work. The proper scientific interpretation of this result is that the treatment (acupuncture) is no different than placebo (sham acupuncture) and therefore has only a placebo effect. Only in CAM world can you take a negative result and then spin it into a positive result like this. Science is all about controlling for variables, and when you control for the variable of acupuncture (inserting needles into acupuncture points) it does not work.

Notice how he also muddies the variables further by mentioning electrical stimulation. Sure – acupuncture really works when you combine it with another modality (transdermal electrical stimulation) that may have some pain benefit by itself. That is like saying – acupuncture really works when you inject morphine through the needles.

The press release goes on:

There is ample evidence supporting the value of acupuncture in migraine treatment, Dr. Dodick noted, including four studies that compared acupuncture to standard migraine preventive medications. Acupuncture was found to be at least as effective and produced fewer side effects. Further, he noted that a randomized clinical trial study published in November comparing acupuncture to topiramate in chronic migraine prevention showed that acupuncture was more effective than topiramate. Topiramate is an anticonvulsant often used in epilepsy.

Let’s take a close look at this study. There were two treatment groups – acupuncture and topiramate. There was no sham acupuncture group, and no placebo medicine group. This means the study was not blinded – given the large documented placebo effect for subjective symptoms and for invasive procedures, this study is worthless. All it is demonstrating is something that is well known – sticking needles in someone has a larger placebo effect than giving them a pill.

Further, the topiramate was titrated up to only 100mg per day. While this dose may have an effect in some patients, other studies (and clinical experience) indicate that some patients need to titrate up to 200mg per day to get an effect. So the topiramate arm was underdosed to some degree, a classic way to show equivalency for a non-effective treatment, compare it to a non-effective dose of another treatment and then claim it works just as well. But worse, the treatment phase was only 8 weeks.  About this Dr. Dodick says:

“Further, the long-lasting effects of acupuncture, given that subjects continued to experience a reduction in migraine frequency two months after treatment, is also noteworthy and not a point to be ignored,” he said.

Two months, however, is nothing when you are talking about migraine prophylaxis. It can take that long for the topiramate to start working. So you should start counting headache frequency after a two month initial treatment period – not during this phase. Other studies showing efficacy in topiramate are 3-12 months long. This is another way to use a gimped comparison group to make the treatment group seem more effective.

Here is a more recent study of acupuncture in migraine that the press release did not discuss. It concludes:

Acupuncture tested appeared to have a clinically minor effect on migraine prophylaxis compared with sham acupuncture.

This also was not a great study. It was single blind only, and also used electrical stimulation. But at least they included a sham acupuncture group, and (you guessed it) no difference between the sham acupuncture group and the two other acupuncture groups. In other words – acupuncture does not work. There were minor difference in the secondary outcomes only, considered not clinically significant by the researchers, and within the noise level of such studies.

Conclusion

Placing needles into acupuncture points (in other words – acupuncture)  has no benefit for migraine, or for any pain or other medical outcome.  Proponents, however, have no problem breaking the rules of science and logic to claim that it does. They rely upon poorly designed studies that are not properly blinded or well controlled, or interpret negative studies as positive. They ignore the well-established facts established for placebo (such as the fact that needling has a larger placebo effect than pills), as well as experimenter and subject bias.

It is astounding that these basic principles of science-based medicine are completely ignored in order to take a promotional tone in favor of acupuncture.

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46 responses so far

46 Responses to “American Headache Society Recommends Placebos for Migraine”

  1. BillyJoe7on 02 Feb 2012 at 3:32 pm

    What and who are the American Headache Society and David W. Dodick? What is the motive behind American Headache Society and David W. Dodick (its president), or are they just science illiterate?

    One of the first clinical trials I read in detail was about the prevention of migraines with acupuncture. The conclusion was that sham and true acupuncture work equally well. The authors also suggested that the control group could now be dropped so they could concentrate on determining the most effective protocol! And this was a Cochrane systematic review!

  2. BillyJoe7on 02 Feb 2012 at 3:34 pm

    David Dodick:

    http://cme.americanheadachesociety.org/cme/course/info.asp?CID=22

    “David W. Dodick, MD, FAHS, FRCPC, FACP
    Professor of Neurology
    Mayo Clinic Arizona
    Phoenix, AZ

    David W. Dodick , MD, FAHS, FRCPC, FACP, is a Professor of Neurology at Mayo Clinic College of Medicine and Consultant in Neurology at Mayo Clinic in Scottsdale, Arizona.

    Dr. Dodick received his medical degree with distinction from Dalhousie University in Halifax, Nova Scotia, Canada. He completed his internship and neurology residency at the Mayo Clinic in Rochester, Minnesota, followed by a fellowship at the University of Toronto, in Ontario, Canada. He is board certified in Neurology by both the Royal College of Physicians and Surgeons of Canada, and the American Board of Psychiatry and Neurology. He is also board certified in Vascular Neurology by the American Board of Psychiatry and Neurology and headache medicine by the United Council for Neurologic Subspecialties.

    Dr. Dodick has authored over 250 publications and has co-authored 5 books. He is President of the American Headache Society (AHS), Editor-in-Chief of Cephalalgia and serves on the editorial board of The Neurologist, Lancet Neurology, and Postgraduate Medicine. He is currently the Program Director of the Mayo Clinic Neurology Residency and Headache Fellowship Programs in Phoenix, Arizona.”

    Impressive!
    So what’s gone wrong?

  3. cwfongon 02 Feb 2012 at 3:56 pm

    He crossed the Rubicon?

  4. fnanfneon 02 Feb 2012 at 4:23 pm

    Ample evidence?

    Luckily I don’t suffer from migraines but can tell you the dozen times or so I’ve had it in my life was the worst pain I’ve ever endured. I struggle to accept that a mere placebo effect can deter a migraine’s terrible onslaught.

    This recommendation is humbug.

  5. tmac57on 02 Feb 2012 at 6:37 pm

    ‘Ive read enough about acupuncture to convince me that it is an elaborate placebo,but how confident are you that Topiramate is clinically effective for migraine headache? Could it be that it is also acting as a placebo? Two months seems like a long time for it to take affect,but I know nothing about this.

  6. ccbowerson 03 Feb 2012 at 10:18 am

    “David W. Dodick, MD, AHS president, said both types of acupuncture, particularly when electrical stimulation is involved, may work…”

    So sham acupuncture is now a “type” of acupuncture? I guess one must also conclude that lactose also treats depression

  7. cwfongon 03 Feb 2012 at 4:22 pm

    Lack of lactose treats depression better.

  8. tmac57on 03 Feb 2012 at 8:28 pm

    “Lack of lactose treats depression better.” …L.O.L. ?

  9. cwfongon 03 Feb 2012 at 11:49 pm

    No joke.

  10. papertrailon 04 Feb 2012 at 4:39 am

    “Placing needles into acupuncture points (in other words – acupuncture) has no benefit for migraine, or for any pain or other medical outcome. ”

    I am very much inclined to agree, but the link you gave to support that statement says: “The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache.”

  11. papertrailon 04 Feb 2012 at 5:21 am

    A more recent review by E. Ernst: http://www.painjournalonline.com/article/S0304-3959(10)00689-5/abstract

    “In conclusion, numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain. Serious adverse effects continue to be reported.”

    Still, he saw good evidence for neck pain alleviation.

    I know people who swear by acupuncture. A friend with a painful degenerative nerve system disorder has been going for years, and the treatments are very painful but she says she feels euphoric afterward, at least for awhile. I wanted to argue about efficacy but placebo effect but to what end?

  12. ChrisHon 04 Feb 2012 at 10:10 pm

    With or without lactase?

  13. cwfongon 04 Feb 2012 at 10:49 pm

    It’s a “giveth and taketh away” proposition.

  14. Steven Novellaon 05 Feb 2012 at 11:17 am

    Fran. You are offering only personal anecdote. Do not assume you are typical. The totality of the clinical research disagrees with you. This magnitude of subjective response is well within the placebo effect.

  15. Nitpickingon 05 Feb 2012 at 11:48 am

    Steve,

    There’s no “Fran” posting here. Do you mean fnanpe? He/she posted that the recommendation was nonsense. Are you referring to fnanpe’s comment that it is hard to believe placebo could have the described effect? That isn’t denial, just a comment on his/her reaction.

  16. sonicon 05 Feb 2012 at 12:27 pm

    BillyJoe7-
    One thing different between Dr. N. and Dr. Dodick is how they define ‘acupuncture’.
    They might agree if they used the same definition for what they are talking about– hard to say.
    To Dr. N. exact needle position is acupuncture– to Dr. D acupuncture involves more than just that. If acupuncture is defined more broadly than ‘exact needle position’, then ‘sham acupuncture’ might not be a true placebo.

    Here is another take from Dr. Halker of the American Migraine Foundation–
    http://www.americanmigrainefoundation.org/service/news.aspx?CategoryId=1&ArticleId=80

    It seems he is defining acupuncture more broadly as well.
    It is difficult to access the level of agreement beyond the fact that the doctors D and H are not discussing the same thing as Dr. N.

  17. Steven Novellaon 05 Feb 2012 at 10:13 pm

    sonic – it’s more than just the definition of acupuncture. They are using a fuzzy definition in order to distort the science. We cannot conclude that “acupuncture” works because placebo acupuncture has a measured effect – because either there is no comparison between sham acupuncture and no treatment or some other placebo, or the comparison is not blinded.

    So really, they are retroactively making the definition fuzzy in order to use poorly controlled evidence to conclude that “acupuncture” works. It is a distortion of the scientific method. It is intellectually dishonest. It is pseudoscience.

  18. amhovgaardon 06 Feb 2012 at 4:49 am

    papertrail:
    “the treatments are very painful but she says she feels euphoric afterward”
    - that should be “and”, not “but”. There’s nothing unusual about a feeling of euphoria following a painful treatment you submit to willingly – ask any masochist. You get a similar effect from really scary experiences that turn out to not kill you after all (parachuting, bungy jumping).

  19. BillyJoe7on 06 Feb 2012 at 5:01 am

    sonic,

    “To Dr. N. exact needle position is acupuncture– to Dr. D acupuncture involves more than just that. If acupuncture is defined more broadly than ‘exact needle position’, then ‘sham acupuncture’ might not be a true placebo.”

    If Dr. D set out to compare true acupuncture to sham acupuncture, then he is taking sham acupuncture to be the placebo arm of the trial. He cannot then, at the end of the trial, when true acupuncture is shown to do no better than the sham acupuncture, redfine sham acupuncture to be true acupuncture.

  20. cwfongon 06 Feb 2012 at 1:39 pm

    Sure he can. Except that he didn’t.

  21. BillyJoe7on 06 Feb 2012 at 3:06 pm

    …well, okay, he was reporting on studies that others did. But he is effectively redefining sham acupuncture to be true acupuncture.

  22. cwfongon 06 Feb 2012 at 3:32 pm

    Common effects from still different procedures does not redefine and redescribe the procedures.

  23. papertrailon 06 Feb 2012 at 9:50 pm

    @amhovgaard

    Yeah, I meant “and” placebo. And, I absolutely agree with you. I wonder sometimes if the feeling people get after acupuncture is related to how people who hang themselves from hooks through their skin feel, but on a smaller scale. And then there’s the mistaken belief that if something hurts, it must be doing some good.

    I actually did begin to (gently, I hope) question my friend about her “treatments” but knew I better stop. I ended up saying “Oh, I’m just a skeptic these days.”

    She believes her acupuncturist has some specialk, rare knowledge, coming from a long line of traditional Chinese acupuncturists. When I mentioned sham treatment proving equal in effectiveness, she thought it made perfect sense because poking the skin stimulates circulation, which, she said, is part of traditional treatment too (so why not dispense with the needles?). I can’t blame a suffering friend for going for something that makes her feel better and more hopeful, but I can resent associations like the American Headache Society, among other mainstream organizations, for making acupuncture sound effective beyond placebo, and then for making placebo sound like a treatment option. When discussing this with people, often I’m made out to be the oddball in the room (closed minded, etc.), first for questioning the dubious treatment (acupuncture, homeopathy, etc.) but, lately, for not giving enough value to the power of placebo. People aren’t even wincing when you point out that placebos are “snakeoil”. I even ended up apologizing to a friend for blowing the cover on his ridiculously diluted homeopathic rememdy (I laughed aloud when I saw 30c) because the healing power of his false hope would be lessened by the truth. He accepted my apology. Life is weird.

  24. sonicon 07 Feb 2012 at 3:07 pm

    Dr. N.-
    When ‘acupuncture’ was tested against the drug topiramate- ‘acupuncture’ got much better results than the drug.
    As you correctly point out, one problem with the study is that the drugs might not have been administered in the proper manner. This is a nuanced position based on an understanding of the procedure under test. (One might say that the researcher’s testing of the drug was based on an incorrect definition of the actual procedures).
    If you knew how acupuncture was used in actual practice, you could see that the trials that are run are not testing acupuncture as it is actually applied. (needles in exact points based on a diagnosis from weeks before– that is not how it is done in practice)
    When you see that, then the problems of these trial results become apparent and one can understand why there is such difficulty in the testing- difficulties that are repeatedly pointed out in the literature.
    And that’s why the definitions matter and need to be correct BEFORE the conclusions are drawn.

  25. Steven Novellaon 07 Feb 2012 at 4:02 pm

    Sonic – you are raising a separate issue, which has been raised before. There are trials of acupuncture where cookbook acupuncture (like most trials) are compared to individualized acupuncture to sham to some usual care – and still there is no difference between individualized acupuncture and sham.

    This comes up with almost every single medical study that fails to find an effect – was the dose high enough, the treatment long enough, the right outcome measures looked at, the right patient population. These are, individually, legitimate questions. Eventually enough different studies get done that we cover an adequate range of variables. After a certain point, however, this becomes special pleading. Acupuncturists have had years and hundreds of studies to show that acupuncture works, and they have shown that it does not work. How many times are they going to dismiss negative evidence with special pleading and redefining terms?

  26. sonicon 10 Feb 2012 at 4:28 pm

    Dr. N.-
    Sorry for the delay in response (I’ve been away)– I’m still a bit confused–
    To be sure– I don’t know that acupuncture works (or not) for any specific condition.
    I’m having a problem with the idea that it has been shown ineffective–

    Problems–
    The only trials where acupuncture is tested as it is actually done are unblinded. This is due to the nature of the treatment (much like message- for example). Further, the actual practices are varied (some use the acupuncture points, some don’t,…). Those studies- where the acupuncturist is allowed to do whatever he wants are overwhelmingly positive in favor of acupuncture over- no care or- in many cases- standard care.
    I could give you a list of hundreds- perhaps 1000′s of such studies– but you know that. The problem is they are not blinded trials- they could be placebo effects.
    This is a valid point.

    In order to blind the trials, something other than acupuncture as it is actually practiced is required.
    I have read numerous attempts to design such experiments- many of the trials seem to be very imaginative and well thought out.
    Yet they all run across the same problem– that is they are not testing what is actually done in practice. Can we admit that?

    We can attempt to infer from the data what would happen if we were to test actual methods and try to tease out the placebo effects and so forth- but the complaint– “That’s not actually a test of the actual procedure,” will remain and is valid. Right?

    (Note- I find it interesting that the ‘better studies’ don’t actually test that which they claim to– very odd. If nothing else this is an interesting study of the difficulties of experimental design– wow!)

    So while it might be true that “There is no scientific evidence to support the notion that acupuncture works for migraine than standard care,” it is also true that those who got the treatment did better than those who did not by every test- even long term- (I’m using the migraine test as the example).

    It seems that a doctor who has a patient with bad migraines who is wanting or willing to try acupuncture would suggest they do.
    After all, by test those that do the treatment will get better results than anything else he has to offer by every test- short and long term.

    Pragmatic– no?
    What am I missing? (That is a real question)

  27. BillyJoe7on 11 Feb 2012 at 2:27 am

    sonic,

    What am I missing?

    Patients reporting they feel better, does not mean they actually feel better.
    Acupuncture has not been shown to work and has very low plausibility.
    There are very effective sham acupuncture needles that retract into the handle instead of piercing the skin.
    When even single blinding is done using these sham needles, the effect practically disappears.
    When that happens, the authors claim both sham and real acupuncture works!
    If the procedure used in trials is not what acupuncturists use in practice, they had better get on with it then.

    Most importantly, taking everything into consideration, acupuncture does not work.

    What we have is no evidence of meridians, no biological basis for acupuncture points, lots of trials with lots of methodological errors seemingly designed to cover the fact that acupuncture does not work, statistical noise, conclusions not based on the data, conclusions contrary to the data, effects reducing towards zero the better the trial design…..

    Short summary: Acupuncture does not work.

  28. cwfongon 11 Feb 2012 at 1:18 pm

    Shorter summary. If BillyJoe7 doesn’t know why something works, then it doesn’t work. Yet he still gets out of bed to go to work.

  29. BillyJoe7on 12 Feb 2012 at 5:24 am

    Here, I’ll make it easier for you…

    Acupuncture is implausible:
    No qi.
    No meridians.
    No acupuncture points.

    Acupuncture has never been shown to work:
    The more methodologically sound the trial the less the affect untill there is no effect.
    It doesn’t matter where you put the needles.
    It doesn matter if you don’t stick them in.
    You can use toothpicks.

    Conclusion based on plausibility and evidence:
    Acupuncture does not work.

  30. cwfongon 12 Feb 2012 at 12:55 pm

    Placebo effect is not an effect? Why not?

  31. amhovgaardon 12 Feb 2012 at 2:08 pm

    cwfong:
    because “placebo effect” in studies includes anything that is not the specific treatment effect you are checking for: things like regression to the mean, getting better because time passes and the illness/problem doesn’t last forever, convincing yourself you feel better even if nothing has changed because you think you should (since you’ve had this great treatment), telling the nice doctors you feel better because you don’t want to disappoint them…

  32. sonicon 12 Feb 2012 at 2:31 pm

    BillyJoe7-
    Allow me to explain in a way I think you will understand–
    I have a method of back scratching.
    I start scratching at the point the person says itches and then I move around a vary the intensity of the scratching based on what the person whose back Im scratching says and does– “A little lower…to the right…” I particularly like it when the person starts going–”Oh yeah, that’s the spot.”
    OK?

    Now if we wanted to test this procedure we would want to blind it– as the procedure I do is not blinded. And one thing that will happen to blind it is there will be no communication between me and the person whose back I’m scratching.
    While this is a valid test of something, you can understand why when the test is done I would feel obligated to point out that the test has removed an important part of what makes the ‘treatment’ work.
    Right?
    While this is an analogy to the acupuncture tests, you will see that in order to blind the tests they stop communication between the acupuncturist and patient. This is needed to blind the test- but you can understand why the practitioner would feel like his method hasn’t really been tested.

    So you understand the problem– if we allow the acupuncturist to do what he normally does we have an unblinded test. But in order to blind the test we have to change the procedure in ways that could effect the outcome unfairly.

    This is what makes it such an interesting study in experimental design.

    I’m sure these problems have not been completely overcome.
    Given the nature of this problem I’m not sure that it makes sense to make a definitive decision and statement about the treatments workability.

    There are two other problems I will take up in a bit–(got to go)…

  33. BillyJoe7on 12 Feb 2012 at 3:31 pm

    cwfong.

    “Placebo effect is not an effect? Why not?”

    The placebo effect is a non-specific effect.
    Anything can give rise to the placebo effect.
    Even treatments that actually work.
    Acupuncture does not actually work.

    Placebo effects are also, in general, quite mild and transitory.
    And they cannot change the outcome of any pathological state.

  34. BillyJoe7on 12 Feb 2012 at 3:45 pm

    sonic,

    “if we allow the acupuncturist to do what he normally does we have an unblinded test.”

    If we have an unblinded test, we have a test of acupuncture+placebo against no treatment.
    Which is useless in assessing the effect of acupuncture.

    “But in order to blind the test we have to change the procedure in ways that could effect the outcome unfairly.”

    All we are doing is removing the placebo effect to measure the effect of the acupuncture itself.
    Which is exactly what we are trying to measure.

    The procedure itself doesn’t have have to change. The acupuncturinst can still perform acupuncture procedure the way he normally performs the acupucture procedure. Of course, he cannot add in any non-specific placebo effects, and he cannot inform the patient whether he is using a true acupuncture needle or a sham acupuncture needle.
    Otherwise you are not testing acupuncture but acupuncture+placebo.

  35. cwfongon 12 Feb 2012 at 3:59 pm

    Billyjoeism: The placebo effect works because it does not actually work. Since it is not actually an effect. Again, who knew.

  36. BillyJoe7on 12 Feb 2012 at 10:13 pm

    Do you ever have anything useful to say?

  37. cwfongon 12 Feb 2012 at 10:48 pm

    There’s more than one way to skin a cat?

  38. sonicon 13 Feb 2012 at 12:45 am

    BillyJoe7-
    So now that you acknowledge that any test of acupuncture as it is actually practiced has no value scientifically and only tests where people do something other than acupuncture have any validity- you understand the difficulty– no?
    (I’m not so sure these problems can’t be solved– I’m just not sure that I’ve seen the solution. And I know I haven’t come up with it for sure.)

    Now to definitions (as promised)
    1) What is acupuncture?
    If we look we find different schools- some think these points are important- others think the points are not so important– some think that the needles should be used a certain way- others think they should be used differently. Some ancient texts actually suggest using dull needles that don’t go into the skin.
    (As an aside– One thing we have learned from the more recent studies is that if you take a toothpick and grind and poke the skin for ten minutes you can achieve a similar effect to having put a needle through the skin at that point. Imagine that.)

    Anyway–you can see that defining acupuncture as ‘exact needle technique and location” is not an accurate description of what acupuncture is (as actually practiced).

    So– from the AHS statement–
    “This suggests the benefits of treatment may not depend on the exact technique of acupuncture and needle position.”
    That is to say there are numerous schools of acupuncture and a variety of techniques all of which may achieve similar results.
    This is an important point.
    After all, if we use a false definition then we could say-
    “Acupuncture doesn’t work, that’s why I go to the acupuncturist. They don’t do acupuncture.”
    And oddly, that is the situation we seem to have.

    2) a problem in the definition of placebo. What is it?
    I’ve heard the problem with placebos is that they are short-lived. This fits with my experience well.
    But if the effects are measurable eight weeks after the treatment, as seems to be the case in the migraine study, then is it a placebo? How many weeks does it take for the placebo effect to wear off?

    Of course it is possible that if I stick a needle in someone’s rear end 8 weeks later they will say they don’t have a headache even thought they have one.
    How cool would that be?

    Further reading–
    As to the ‘sham’ equals ‘placebo’ try here–
    http://www.ncbi.nlm.nih.gov/pubmed/19183454

    Please note- none of what I’ve said here has anything to do with ancient explanations as to why acupuncture works.

  39. BillyJoe7on 13 Feb 2012 at 5:28 am

    sonic,

    “So now that you acknowledge that any test of acupuncture as it is actually practiced has no value scientifically and only tests where people do something other than acupuncture have any validity- you understand the difficulty– no?”

    No.
    Acupuncturists practice acupuncture+placebo.
    We know placebos have an effect.
    We want to know if acupuncture has an effect.
    When acupuncture is tested against acupuncture+placebo, the acupuncture is shown to have no effect.

    “What is acupuncture?
    If we look we find different schools- some think these points are important- others think the points are not so important– some think that the needles should be used a certain way- others think they should be used differently. Some ancient texts actually suggest using dull needles that don’t go into the skin.
    (As an aside– One thing we have learned from the more recent studies is that if you take a toothpick and grind and poke the skin for ten minutes you can achieve a similar effect to having put a needle through the skin at that point. Imagine that.)”

    So sham acupuncture = true acupuncture = toothpicks!
    Congratulations, sonic, you have just identified the problem.

    “Anyway–you can see that defining acupuncture as ‘exact needle technique and location” is not an accurate description of what acupuncture is (as actually practiced).”

    Perhaps you can see that acupuncturists have discovered that they can do almost anything and still get the placebo effects – and only placebo effects – they have always been getting.
    If a+placebo = b+placebo = c+placebo = d+placebo = e+placebo, what role do you believe a, b, c, d, and e play?
    What is “e” is “scratch around on the skin with toothpicks”?

    “…there are numerous schools of acupuncture and a variety of techniques all of which may achieve similar results. This is an important point.”

    Then why not just scratch around on the skin with toothpicks and be done with acupuncture and acupuncturists?

    “I’ve heard the problem with placebos is that they are short-lived…But if the effects are measurable eight weeks after the treatment, as seems to be the case in the migraine study, then is it a placebo? How many weeks does it take for the placebo effect to wear off?”

    The placebo effect did not cease 8 weeks ago. It continues to be elicited whenever questions are being asked of the participants. The more important point, though, is that placebos have no affect on the underlying pathology

  40. BillyJoe7on 13 Feb 2012 at 5:39 am

    sonic,

    “As to the ‘sham’ equals ‘placebo’ try here–
    http://www.ncbi.nlm.nih.gov/pubmed/19183454

    So what is left of acupuncture?
    It seems there is no qi, no meridians, no acupuncture points, no need to accurately place the needles, no need to stick the needles in, no need to use needles.
    So…is scratching around on the skin with toothpicks acupuncture?
    (I wonder how many acupuncturist you could get to agree to that proposition!)
    If so, do acupuncturist require any training?
    If not, should we even use the term acupuncturist for these toothpickerskinscratcherarounderists?

  41. cwfongon 13 Feb 2012 at 12:25 pm

    So in sum, acupuncture works because it does not actually work, since it is not actually an effect.

  42. BillyJoe7on 13 Feb 2012 at 3:02 pm

    If you keep trying really hard I’m sure that one day you’ll get it.

  43. cwfongon 13 Feb 2012 at 4:09 pm

    So you and yo’ mama keep telling us.

  44. cwfongon 13 Feb 2012 at 4:18 pm

    “Clinical studies showed that both acupuncture and minimal acupuncture procedures induced significant alleviation of migraine and that both procedures were equally effective. In other conditions such as low back pain and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and conventional non-acupuncture treatment. ”

    “If you keep trying really hard I’m sure that one day you’ll get it.” (Or not)

  45. BillyJoe7on 13 Feb 2012 at 10:18 pm

    …seems you need to keep trying ;)

  46. cwfongon 13 Feb 2012 at 11:41 pm

    Not a problem.

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