Dec 11 2008

New Stats on CAM Usage

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Comments: 29

The Wall Street Journal declares, “Alternative Therapies Have Gone Mainstream.” The Washington Post claims, “Survey Documents Rise in Alternative Treatments.” (That headline was in the RSS feed.) Reuters writes, “Many Americans turning to unconventional medicine.”


They are talking about the 2007 National Health Statistics report on CAM use by Americans.  This data was actually released in September. I went through the statistics at the time and reported on them for Science-Based Medicine. I guess that was too much work for most journalists, so they waited three months to be spoon-fed the data by the NCCAM. They also appear to have been spoon-fed their conclusions, for none of the outlets even comes close to getting it right.

In fact, the statistics show the opposite of what the headlines proclaim – for as long as statistics have been gathered on CAM use the numbers have been remarkably stable – not increasing.

Here are the actual numbers reported by the survey:

Modality                       % used Ever             2002                 2007

Acupuncture                    6.55                          1.1                    1.4
Ayurveda                         0.56
Biofeedback                     1.23                           0.1                    0.2
Chelation                          0.34
Chiropractic or
Osteo Manipulation       21.91                         7.5                    8.6
Energy Healing                1.72                          0.5                   0.5
Hypnosis                          2.34                          0.2                    0.2
Massage                           16.02                        5.0                    8.3
Naturopathy                    1.51                          0.2                    0.3
Homeopathy                    3.65                          1.7                     1.8
tai chi                                 0.9
qi gong                               0.6
yoga                                   9.53                          5.1                     6.1

These numbers are not significantly different than 20 years ago. Also, the “significant increase” that proponents are crowing about and the press are parroting are hardly significant. The numbers for manipulative therapies in 2007 include chiropractic and osteopathy while the 2002 numbers include chiropractic only, so the comparison is not valid. Massage increased by 3.3 percent. Otherwise the numbers are static or just slightly increased.

Also, the numbers reveal the hollowness of the CAM label – what does CAM really mean? The numbers are inflated by including items that are not necessarily out of the mainstream. Massage is a perfectly reasonable modality for muscle relaxation. I would only consider it “alternative” if pseudoscientific therapeutic claims were being made for it, and this survey does not capture that information. Biofeedback is established for stress reduction and some symptomatic relief of tension headache and similar conditions. Yoga is exercise and stretching. Also, manipulative therapy is reasonable for uncomplicated acute lower back strain, with is what about 60% of manipulation is used for.

If you factor out these modalities (and also legitimate use of nutrition), the numbers remaining are all quite low – in the single digits, and not significantly increasing. Only 1.8% of the population used homeopathy, 1.4 acupuncture, 0.3 naturopathy, and 0.5 energy healing. For these hard-core CAM modalities usage is still marginal and not really changing.

What the headline should read is, “Despite unfounded hype, political activism, poor regulation, and promotion by gullible media – use of CAM modalities remains minimal and fringe.”

The Washington post reports “38% of Adults use Alternative Medicine.” But as should now be clear, that 38% figure is inflated and misleading. They also did not question or explore the “alternative” label. What they did do is quote Dr. David Eisenberg, who has been misrepresenting CAM statistics for years:

“I think it’s fair to say we can conclude that this is part of the steady state of medical care in the United States,” said David Eisenberg, director of the Harvard Medical School’s division for research and education in complementary and integrative medical therapies. “I think the news is complementary and alternative medicine use by the U.S. public is here to stay.”

I think it is fair to say that the abuse of statistics by CAM proponents to create the illusion of mainstream acceptance, despite the numbers, is here to stay. This is nothing more than pro-CAM propaganda, unfiltered by journalism.

For balance they did interview Wallace Sampson, who also blogs with me at SBM.

“They are either unproven or disproven,” said Wallace Sampson, founding editor of the Scientific Review of Alternative Medicine. “Acupuncture is a placebo. Homeopathy is one step above fraud. It goes on and on. The fact that they are so widely used is evidence for how gullible large segments of our society are.”

I know from my prior discussions with him that Wally believes the numbers to be inflated exactly as I have discussed, so I suspect he was selectively quoted here. His point is legitimate, but does not address the bigger deception that I discuss.

They also quote Stephen Barrett from Quackwatch.

“There’s a tremendous amount of money being wasted on this,” said Stephen Barrett, who runs Quackwatch (, which monitors false medical claims. “That money could be used to do research on something that has been waiting in line to get money.”

Again – a legitimate point. But there was nothing in the article discussing the misrepresentation of the numbers, and if the reporter, Rob Stein, spoke to Wally Sampson and Steve Barrett it is very likely that he was made aware of this concern. (I will ask them about this and add an addendum when I have more information.) It seems as if the media had their story – CAM gone mainstream – and that was the story they were going to write. Quotes from skeptics are usually just plug ins, they don’t alter the main theme of the story itself. This is a disturbing habit among journalists – writing the story prior to doing the research, and conducting interviews only to provide quotes to plug into the existing story framework.

While I am always annoyed by such journalistic failures when dealing with CAM, I am at least heartened that the numbers for use of core CAM modalities remains so low and are barely fluctuating. And at least now the media are (sometimes) adding at least token scientific comments. Perhaps there’s hope after all.


Addendum added 12/16/08

At least one mainstream outlet, US News and World Report, saw through the spin and hype to the real numbers. Avery Comarow gets it right.

29 responses so far

29 Responses to “New Stats on CAM Usage”

  1. jugaon 11 Dec 2008 at 10:17 am

    So, you say something can only be considered “alternative” if “pseudoscientific therapeutic claims were being made for it”. In other words, if anything on the current list of CAM starts to be used by more people because it gets scientifically validated, it does not represent an increase in CAM because it is no longer CAM.

    This makes any reporting of percentage of CAM use essentially meaningless, whether it says use has increased, stayed the same or reduced.

    Defined CAM as “the things that don’t work”, doesn’t seem to me to add anything to the debate. It just begs the question.

  2. Steven Novellaon 11 Dec 2008 at 10:55 am

    juga – you miss the point entirely. I am not removing things from the CAM list because they have been subsequently validated. Proponents of CAM have added modalities that already existed and may have been supported by scientific evidence under their vague umbrella of CAM. They have tried to co-opt some mainstream modalities, like nutrition, and make it their own to inflate their numbers and have something to lend legitimacy to CAM.

    But the deeper problem is the CAM label itself – it is meaningless except for propaganda purposes.

    Rather – individual modalities should be considered individually.

  3. CrookedTimberon 11 Dec 2008 at 11:30 am

    Sounds like a good opportunity to fire off an Op-Ed, perhaps in conjunction with the colleagues mentioned.

    Dr N have you ever considered compiling a list of common quack claims and the appropriate rebuttals? I find the handbooks about how to deal with creationist claims to be invaluable and a similar work with CAM would surely be as well.

  4. Michael.Meadonon 11 Dec 2008 at 11:38 am

    Thanks Steve. It seems you’re right that the journalists just lifted their conclusions form NCCAM – here is the press release their stories appears to be based on.

    I hate journalists. Srsly.

  5. Michael.Meadonon 11 Dec 2008 at 11:45 am

    juga – I agree with Steve. As Richard Dawkins (and many others) has said “There is no alternative medicine. There is only medicine that works and medicine that doesn’t work”. C.f. artemisinin.

  6. Potter1000on 11 Dec 2008 at 12:15 pm

    I’ve only seen the headlines and haven’t read any of the articles, because I figured you would do a post about it and explain it for me, Dr. N.

    So thanks!

    And I second everything CrookedTimber said.

  7. superdaveon 11 Dec 2008 at 1:33 pm

    If something is calling itself complimentary and alternative, it is by definition out of the mainstream.

  8. psamathoson 11 Dec 2008 at 2:16 pm

    These numbers are heartening. I’m glad to see that SCAM is still on the fringe and I hope it remains so. This post goes well with Mark Crislip’s entry last week in Science Based Medicine about Google searches for alternative treatment modalities. Unfortunately numbers as small as 3.65% (for homeopathy) still represent an awful lot of people in a representative national survey.

  9. SidBBon 11 Dec 2008 at 2:55 pm

    It’s sorry reporting.

    An article in the Chicago Sun-Times has the headline “Use of alternative medicine on the rise” but then in the body of the article you also find this: “The survey also shows that overall use of alternative medicine has remained stable since 2002.”

    On a positive note, I found this Newsweek article that has a more cautionary tone and summarizes recent studies nicely.

  10. daijiyobuon 11 Dec 2008 at 5:29 pm

    Participate in my digg of the WSJ’s credulity / junk journalism!


  11. Karl Withakayon 11 Dec 2008 at 7:16 pm

    RE: Homeopathy numbers:

    It’s hard to find good information on remedies that label themselves as homeopathic, but I wonder if there isn’t some fraudulent fraud going on there. I suspect that there are commercial herbal remedies and supplements that label and promote themselves as homeopathic because it’s good marketing, but aren’t homeopathic preparations involving the law of similars, dilution, and succussion. Thus it would be possible for people taking herbal remedies and supplements containing actual (if unproven) ingredients in them they believe to be homeopathic based on the claim on the label to report taking homeopathic remedies when they are not.

    I didn’t really see a category for herbal remedies and supplements; I guess that would sort of fall under Naturopathy, but not necessarily. I would guess that Naturopathy and Homeopathy numbers are artificially high from people who took herbal remedies and supplements and reported in those categories.

    I don’t have time to look it up right now, but wasn’t this a poll of what forms of CAM one had used EVER? To use such a poll to claim that CAM has become mainstream would be like using a poll on whether one had EVER tried illegal drugs to claim that illegal drug use is mainstream. -Doesn’t follow.

  12. PrimroseRoadon 11 Dec 2008 at 8:14 pm

    According to my former chiropractor’s newsletter (which I remain subscribed to for a good laugh now and then), the WSJ article and the fact that the American Association of Pediatrics now “recognizes the increasing use of complementary and alternative medicine in children and, as a result, the need to provide information and support for pediatricians” show that more people are turning to “natural” health care. The newsletter also notes that with 210 additional hours of training (past the D.C.), chiropractors may practice on pets as well as humans. Hmm.

  13. halincohon 11 Dec 2008 at 9:02 pm


    Recently I had a patient come in with suddenly worse lipids despite his use of Crestor. When questioned, he revealed he was taking Crestor only 2-3 times per week. His wife, his wife’s chiropracter, and his wife’s friend told him to “stop taking that poison.” Instead he was talked into taking red rice yeast. I spoke to him about end point data; i.e. whether or not the medication, herb, or supplement reduces an actual disease burden. As you know, statins reduce the frequency of cardiovascular disease, stroke and peripheral vascular disease whereas the results of herbs and supplements on disease outcome are minimal or variable at best. For example, garlic in LARGE quanties lower cholesterol a little, but there is no research substantiating that it lowers heart disease. Statins, depite thier relatively rare side effects ( liver enzyme increase, myalgia and more rarely myositis, and hyperglycemia ) are simply the most efficacious treatment for dyslipidemia, mostly because of their superior LDL reduction and , also in large part, due to their effect on endothelial inflammation, because this lowers disease consequences , not merely lab numbers.

    As a D.O. I’m sensitive to osteopathic manipulation labeled as alternative medicine. If it’s used as adjunctive therapy for myofascial pain I see it as simply a cousin of physiatry or physical therapy and that’s main stream. This is how I use it ( it’s a minimal part of what I do , but it’s a nice tool to have when needed). But if it’s used to improve asthma, alter autonomic functioning, or treat something else that doesn’t have a sound physiological , biochemical, or anatomical basis, then it’s fringe medicine and deservedly should be called alternative.

    Back to red yeast guy – what I didn’t know was that red rice yeast has come under the scrunity of the FDA. Why? Because some studies showed that in high risk patients it actually did reduce cardiovascular risk. Why is that bad? Cause the friggin’ stuff was laced with lovastatin, a STATIN, the catagory of drug that Crestor belongs to. At least I can warn MY patients who take a statin about potential side effects. But if herbal companies are putting drugs in their stuff without my knowing it, then both me and my patient are screwed. It’s bad enough that I had to teach myself herb-herb and herb-drug interactions, but don’t hide the damn information from me ( or my patient ). If you are alternative, stay alternative, don’t cheat. Be judged on what you are and what you do.


    Finally, when RED YEAST guy was leaving he had a request, actually this request came from his wife again: do I have any samples of Cialis?

    I really burst out laughing, for after spending huge junk of time explaining how studies are ran, what the results are for statins, what the history of their side effects are, how this compares to studies on herbs and supplements, and how this wasn’t a poison as infered by his wife, SHE wants HIM to ask for Cialis.

    It gives to meaning to ” pick your poison” I guess.


  14. halincohon 11 Dec 2008 at 11:06 pm


  15. halincohon 11 Dec 2008 at 11:11 pm

    And then there’s this: when CAM isn’t really CAM at all:


    “Update on Red Yeast Rice
    Desperately seeking red yeast rice? Consider generic statins.
    By Richard N. Fogoros, M.D.,
    Updated: June 18, 2008 Health’s Disease and Condition content is reviewed by our Medical Review Board

    Results from a large randomized trial conducted in China, published in the American Journal of Cardiology, show that, in patients with prior myocardial infarctions (heart attacks) who were given an extract made from red yeast rice, the risk of having another heart attack and the risk of dying were reduced by nearly 50%.
    In the Chinese Coronary Secondary Prevention Study, nearly 5,000 heart attack survivors received either Xuezhikang (XZK, a red yeast rice extract) or placebo in a double-blinded randomized clinical trial — neither the patient nor the doctors knew which substance individual patients received. After an average of 4.5 years, patients receiving XZK had a 45% relative reduction in heart attacks and in death.

    The XZK extract from the red yeast rice contains several compounds, but the predominant one is lovastatin, a statin drug marketed in the United States as Mevacor and Altocor. Lovastatin is thought to explain most of the beneficial results seen with this study, but whether it is the sole explanation or whether some of the other components of XZK are playing a role is currently unknown.

    Red yeast rice in the United States
    Thanks to the FDA and the federal courts, there has been a lot of confusion about the red yeast rice products available in the United States. In the late 1990s, studies showed that this over-the-counter dietary supplement was quite effective at reducing cholesterol levels, mainly because one of the natural ingredients in red yeast rice turned out to be lovastatin. (Statins were originally derived from yeast products; the lovastatin in red yeast rice is “natural.”) When the FDA figured out that red yeast rice contained a regulated substance, an effective drug protected under patent law, it banned red yeast rice products, unless manufacturers took extra steps to remove the lovastatin.

    The question of whether the red yeast rice products available in the United States over the past decade have actually been allowed to contain lovastatin or not is remarkably complex. The bottom line is that for the past several years, lovastatin-containing red yeast rice is clearly illegal. You can read about lovastatin, red yeast rice and the feds here. Nonetheless, as recently as the summer of 2007, the FDA issued “warnings” that certain over-the-counter red yeast rice products from at least two companies still contained lovastatin and announced that it was taking immediate steps to remove these illegal products from the shelves.

    The bottom line:
    Several randomized trials now show that unadulterated red yeast rice, or the XZK extract from red yeast rice, can substantially reduce cholesterol levels and/or reduce cardiac risk in high-risk patients, and the most likely explanation for this benefit is that these effective red yeast rice products contain a statin.

    A suggestion:
    Judging from the scores of communications I have received over the past few years, many readers of this site are spending a fair amount of effort trying to find sources for the “real deal”: unadulterated red yeast rice, fully loaded with lovastatin, that has escaped the FDA’s scrutiny. (Note to readers: I have no idea whatsoever where to find such stuff as this, and if I did know — not wanting to go to jail — I could not tell you.) It is virtually impossible for a consumer to know whether or which red yeast rice products sold in the United States still contain lovastatin. Apparently some still might, despite a decade of efforts by the FDA to eliminate such products. Any that do contain lovastatin are illegal.

    So here’s a suggestion: Instead of wasting your time and money looking for something which you can never really know you have found, why not talk to your doctor about generic statins? At least three are now available (lovastatin, pravastatin and simvastatin), and they are not much more expensive than red yeast rice. As a bonus, the statin dosage is actually known (unlike with “natural” red yeast rice) and can be logically adjusted to optimize your results. And think of all the gas you’ll save by not having to drive to 20 to 30 stores to find the last few bottles of effective red yeast rice before the feds do.


    Lu Z, Kou W, Du B, et al. Effect of Xuezhikang, an extract from red yeast Chinese rice, on coronary events in a Chinese population with previous myocardial infarction. Am J Cardiol 2008; 101:1689-1693. “

  16. oderbon 12 Dec 2008 at 12:47 am

    Since I started reading this blog – and even more so with Science Based Medicine, I’ve been puzzled by the high proportion of posts dealing with CAM and the intense animus towards CAM.

    The survey reinforces my puzzlement- since there are only a couple of percent of the population – and that number is not growing – that use CAM as defined as implausible and non evidence based modalities let’s get on with other issues – like the corrupting influence of Big Pharma on research and practice, the use of high tech when low tech is just as effective in many cases, ..the tens of thousands killed by drugs, hospital infections and so on….

  17. SGU FTWon 12 Dec 2008 at 7:33 am

    Steve needs to use the word fail more often in the podcast.

  18. Karl Withakayon 12 Dec 2008 at 11:15 am

    Hummm, you lament about the attention blogs devoted to science based medicine pay to CAM topics, you use term Big Pharma (with the requisite caps B & P), and insist the issues that need to be addressed are really-

    “corrupting influence of Big Pharma on research and practice, the use of high tech when low tech is just as effective in many cases, ..the tens of thousands killed by drugs, hospital infections and so on….”

    And you visit sites with the following subtitles:

    Subtitle from this site:
    “Your daily fix of neuroscience, skepticism, and critical thinking.”

    Subtitle from Science Based Medicine:
    “Exploring issues and controversies in the relationship between science and medicine.”

    I fail to understand how you are puzzled by the focuses and topics you find in these sites, given their subtitles. Apparently you are puzzled by the fact that any site devoted to medicine does not share your agenda.

  19. Karl Withakayon 12 Dec 2008 at 11:19 am

    By the way, oderb,

    I spend about two seconds looking at the top of the page and found this cool link: where you can suggest topics.

    It might be nice if SBM had a similar link, but you con email most of the authors with a suggestion anyway.

  20. Joeon 12 Dec 2008 at 2:56 pm

    Steven, if you dispute the 38% number for overall, what number do you propose (sorry if I missed it)?

    For example, you write “Also, the numbers reveal the hollowness of the CAM label – what does CAM really mean [damn right]? … Also, manipulative therapy is reasonable for uncomplicated acute lower back strain, [which] is what about 60% of manipulation is used for.” That number is doubtful- there is evidence that chiros offer relief comparable to that offered by masseurs. However, how much of that 60% is wasted on “maintenance” adjustments?

    Quacks want to inflate the number for ad pop arguments. We want to advocate for a large problem from sCAM. I remain confused about how many people are affected by quackery.

  21. Fifion 12 Dec 2008 at 3:28 pm

    It should be noted that the WSJ was bought by Rupert Murdoch (it’s rumoured he did it partly to try to atone – aka fluff his public image – for Fox News).

  22. sonicon 12 Dec 2008 at 8:17 pm

    Journalists often write the story and then do the research. I have been reported on or have been part of an event that was reported on many times over the years. The stories have never matched the facts, but the stories are consistent. (Journalists are trained to believe reading previous news reports is the best form of research)

    With the above caveat- from the current report-

    On page 1 the claim is that Asian adults use CAM less than white adults- a result I find funny since the numerous Asian adults I know (my business partner for years is Asian) all use Chinese medicine at times. So it seems the report is no doubt underestimating the use of ‘alternative’ therapies.

    This is from the Newsweek article- “The report, which uses data from the 2007 National Health Interview Survey, also provides even more specific clues about the most likely consumers of these treatments: 50-somethings who have graduate degrees, are relatively well off financially, live in the West and have quit smoking.”

    So we have a group of well-educated, successful, physically active people taking part in these treatments. That certainly fits with my experience. These people no doubt feel the treatments work and that they can make up their owns minds in regard this. (I’m guessing this due to the fact that older, well educated, successful people are often this way.)

    If we want to go after fraud and stop those using fraud to enrich themselves- consider this-

    If we look at the ‘scientific ethical’ drug industry we have different findings. According to the Wall Street Journal today (and this has been well known for years) the drug companies publish about 40% of the trials they run on drugs that get approval. We can guess this is because 60% of the trials show the drugs to be ineffective. This is a worse record than one would have testing placebos.
    It takes billions and billions of dollars in advertising to get people to take these drugs and the people who prescribe them need to spend billions of dollars on the largest team of lawyers in the world to protect them from the mountains of litagation that the poor people who are maimed by these drugs produces.
    So we have a fraud that effects every person (your tax dollars pay for these drugs) that is costing people literally 100’s of billions of dollars and has been going on for decades.

    This also makes it seem the real valuable drugs are more dangerous and less effective than they actually are because they are promoted in the same way by the same people who are selling the poisons.
    This causes people to question the value of science as well. (Vioxx is science?= Science is a horrible death producing fraud. Not an illogical conclusion…)

    When will the skeptics take on the real criminals?

  23. Joeon 13 Dec 2008 at 2:49 am

    @sonic (and oderb),

    How did you discover the “crimes” you decry? I’ll tell you- scientific medicine is constantly seeking to correct itself. Every treatment carries a risk; however, quacks deny it. Since they won’t do the job, somebody should.

    Consider the useless, chiropractic neck snap. As the evidence mounts that the risk of stroke (and death) exceeds any small benefit (which can be achieved more safely, other ways) chiros deny the reports. It has become clear that the bilateral vertebral artery dissection is chiropracty’s unique gift to humanity; but you won’t hear it from them, you’ll hear just the opposite.

    In fact, their argument is outrageous: “We don’t cause strokes, victims arrive with the artery dissection in progress as demonstrated by their stiff necks and headaches.” So, DCs have not figured out that they should not snap the necks of people with these complaints!?

    When will the alties police themselves?

  24. DevilsAdvocateon 13 Dec 2008 at 4:20 pm

    I have trouble with the concept that patients can decide for themselves if an alternative therapy or application works or not. This implies the effect is so small that any opinion as to efficacy is valid or supportable, as opposed to a result that is clearly and irrefutably effective or ineffective. This sounds to me like pure placebic effect and suggests the alternative therapy or applications are for complaints so light, so minor, that placebo effects satisfy, or even that being ‘cool’ and current by using alt-med suffices to conclude it ‘works’.

  25. Fifion 13 Dec 2008 at 4:46 pm

    sonic – A large part of it is simply that older, educated people have more extra cash to waste and there’s a rather frantic Boomer war on aging going on (it is, after all, one of the most entitled generations we’ve seen). These people tend to believe that CAM is evidence-based since they have a naive trust in things labelled “alternative” and, since it’s about “wellness” not actually curing anything, the placebo effect is actually part of what they’re chasing since feeling better or good IS “wellness”.

  26. sonicon 13 Dec 2008 at 10:03 pm

    DevilsAdvocate, Fifi-
    Full disclosure–
    I was needing an operation to fix up my elbow. This operation would cost at least $6,000 and leave me incapable for many months. It was suggested that after the operation I would have to take mind-numbing addictive drugs regularly to deal with pain.

    Three accupunture treatments and the pain was gone and I don’t need the operation. This is what happened to me 5 years ago. (Pain still gone- elbow healed) You can understand that I don’t care that somebody thinks that accupunture doesn’t do anything. I know I saved over $5,500, got full use of my arm in a couple days instead of months, and did not have to subject myself to the addictive, liver killing drugs.

    You are both correct that the standard that these treatments are generally held to is- “This works for me.”
    I would suggest this is a reasonable standard for someone wishing to be healthy, since “I feel good,” is somewhat subjective as well.

  27. Clinton Huxleyon 15 Dec 2008 at 9:02 am

    The pharma industry would be licking it’s chops with glee if it could operate under the same burden of proof as apparently applies to hot-air based medicine. It’d save a fortune on clinical trials.

  28. DevilsAdvocateon 15 Dec 2008 at 9:53 am

    Fifi: “A large part of it is simply that older, educated people have more extra cash to waste and there’s a rather frantic Boomer war on aging going on (it is, after all, one of the most entitled generations we’ve seen).”

    As a member of your entitled boomer generation, may I ask what it is I feel I am entitled to? Apparently I am ignorant of something about myself that you hold as knowledge. The question is rhetorical; the fact is there is more exception than rule in your sweeping generalization.

    Sonic: Thy name is personal anecdote. You are welcome to value your experience with acupuncture and your elbow, however, the medical community is ethically bound to consider the entirety of the evidence as regards the efficacy of acupuncture as a medical intervention.

  29. Karl Withakayon 15 Dec 2008 at 4:09 pm

    >>>”I know I saved over $5,500, got full use of my arm in a couple days instead of months, and did not have to subject myself to the addictive, liver killing drugs.”

    Yes, and that is all you know. You do not know if the acupuncture had any real effect at all beyond placebo. You do not know whether the outcome would have been the same without the acupuncture; you merely know that it turns out that the surgery was apparently not required to alleviate your suffering.

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