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

“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?

“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

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.