A presentation is being given today at the 96th Scientific Assembly and Annual Meeting of the Radiological Society of North America.
A couple of media outlets have jumped on this presentation, titled “Influence of Acupuncture on Pain Modulation during Electrical Stimulation: An fMRI Study“.
The headline in the Telegraph reads: Acupuncture’s effect ‘isn’t just psychological’
In the Daily Mail it reads: Acupuncture is no placebo and does relieve pain, say scientists
The Telegraph headline is misleading, and the Daily Mail headline is just plain wrong. And, as I’ll point out, both are overstating the findings of the study, as are the scientists who performed it.
So first off, fMRI stands for Functional Magnetic Resonance Imaging. It is a type of MRI scan which can determine which parts of the brain become “activated” by measuring the amount of blood flow to each part of the brain.
It is a fascinating field of study, and in a future post I will explain the physics of MRI, but for now lets just say that fMRI is (somewhat) able to tell which parts of the brain “turn on” when you do certain tasks.
So what happened in this particular study is this: the authors got 18 healthy volunteers and shocked their ankle with an electric shock to induce pain. At the same time, they imaged their brain using fMRI.
Next, they took the same 18 people, performed acupuncture on them, and then shocked their ankle again and took another fMRI of their brain.
They compare the two images, before and after the acupuncture, to see which parts of the brain light up (or don’t) to see if they could see any differences in how the brain reacts to pain stimuli with and without acupuncture.
And wouldn’t you know it? They did see a difference. Their conclusion:
Activation of brain areas involved in pain modulation was significantly reduced or modulated under acupuncture and the majority of the detected areas were not influenced by the analyzed covariate. However, left anterior insular cortex and orbitofrontal / superior frontal gyrus activation was modulated by stimulus intensity. We hypothesize that insula activation seems to be correlated to the stimulus and pain intensity while the importance of frontal activation increases during acupuncture and may be an acupuncture specific effect.
Essentially, they found that after the acupuncture, parts of the brain which control pain were not activated as strongly. Not only that, but the affective response to pain (the frontal cortex) was changed after the acupuncture as well. Pretty convincing right?
No. It’s not . First off, a similar response has been shown by Wager et al. in 2004 that placebos induce the same effect.
Second, it has also been shown that expecting pain can alter one’s response to pain. This study had the volunteers get their ankle shocked first, then they got acupuncture and had to be shocked again. They were expecting the pain, so this may have affected the results.
Third, there was no control group. A proper study should have had a placebo type of acupuncture, such as pricking the skin with toothpicks (which has been done before) or placing the needles at non-acupuncture points. Or they should have tried some other type of pain relief, like massage or relaxation prior to the second shock, to see if there was any difference.
Fourth, the study only had 18 volunteers. To make a claim that acupuncture works based on such a small group is irresponsible.
Fifth (geez, five points?!) fMRI is not easy to gather accurate conclusions from. The workings of the brain are affected by many things and brain responses can be non-localized.
I am not refuting the results of the study, only the conclusions drawn by the authors and the media. The data itself is not surprising. In fact, it is exactly what you would expect since placebos have shown similar results. But to draw the conclusion that this is an acupuncture specific effect from this data is fallacious.
A recent review article published in the The International Journal of Risk and Safety in Medicine has found reports of 86 deaths in the last 45 years relating to acupuncture treatment.
Incorrectly placing needles and poor sterilization techniques were the main culprits. These poor practices led to punctured hearts and lungs, infections, liver and artery damage and haemorrhages.
From the Guardian,
The most common cause of death was a condition called pneumothorax, where air finds its way between the membranes that separate the lungs from the chest wall and causes the lungs to collapse.
The article was written by Edzard Ernst, a professor of complementary medicine at the Peninsula Medical School in Exeter. When describing his research he said that “these fatalities are avoidable” but are “the tip of a larger iceberg.”
Now, every medical treatment has some form of risk associated with it. What is important is the risk/benefit analysis of the treatment. If you could potentially save a life, the benefit is high which could make a risky procedure worth it.
The problem with acupuncture is that it has consistently been shown to offer little more than a placebo effect. Therefore, if it has no benefit than even a very small amount of risk is unacceptable.
When discussing complementary and alternative medicine (CAM) treatments I always get the question, “Well, whats the harm?”
Studies like these and websites like Whatstheharm.net are showing the growing amount of evidence that some CAM treatments are not as safe as we once thought.
I guess you could call this post “Part 2” in my examination of science reporting in Canada’s national newspaper The Globe and Mail.
Acupuncture is a traditional Chinese medicine wherein needles are inserted into the skin. The needle insertions are supposed to redirect the flow of qi energy in the body, which subsequently cures whatever ails you. (Check my previous post about acupuncture for a more thorough explanation).
Scientific consensus is that acupuncture offers nothing more than a placebo effect. Yet, most insurance companies continue to cover it (including mine).
So when I saw an article about acupuncture in The Globe, was ready for more fodder for my skeptical mind. But I was pleasantly surprised. Somewhat. Just a little.
The article reports on a recent review of 10 studies looking at acupuncture as a therapy for stroke patients. Not surprisingly, the researchers found no evidence that acupuncture helped the recovery of these patients.
While the article does a good job making this finding clear, it does cloud the issue by talking about the supposed “problems” with studying acupuncture.
One of the most glaring problems confounding the study of acupuncture is that it’s challenging to compare it to anything. While researchers studying the effects of a drug can make a direct comparison by giving some patients the medicine and others a placebo, the same isn’t true of acupuncture. Researchers often give one group of patients acupuncture and use a “sham” therapy on another group, in which needles are inserted at non-acupuncture points in the body.
The problem with that approach is that patients may still get a benefit from the “sham” needles, even if they’re not inserted at the correct points in the body.
The “sham” treatment is the placebo in this type of study, and these sham treatments are often developed with the help of trained acupuncturists. The fact that sham acupuncture gives a similar benefit to the patient as regular acupuncture is not a “problem”, it is evidence. Evidence that acupuncture does not provide any benefit other than a placebo. If the treatment does not provide a statistically significant effect beyond that of a placebo, it is not effective.
Proponents of acupuncture usually try to fog the minds of potential customers by saying that acupuncture cannot be studied by standard “Western” practices; that it should be exempt from scientific study because it is somehow “different”. Even the Globe and Mail article manages to contradict itself on this point:
Dr. Korner-Bitensky said there is no solid evidence showing stroke patients can truly benefit from acupuncture.
“For patients and families I would say [acupuncture is] not where you want to put your major commitment in terms of therapy,” she said.
But there’s another important point that shouldn’t be discounted, Dr. Korner-Bitensky added: Some patients simply believe in acupuncture therapy, and that alone could somehow benefit them.
Sorry, but science is a methodology, not an ideology. “Belief” is not enough. If acupuncture produced a real effect, it should be testable and quantifiable. But it doesn’t.
Now the question always arises at this point: “Even if it is just a placebo, why is that bad? It still makes people feel better. Why can’t we let it continue?”
There are several reasons. The first is that if acupuncture is covered by health insurance, it means that we are all collectively footing the bill for a medical treatment that doesn’t work.
Second, if we allow a treatment which doesn’t work to continue, we open the door for similar treatments and ideology to become mainstream, such as faith healing or homeopathy.
Third, if we continue to allow treatments which don’t work to exist, we run the risk of ordinary people choosing “alternative” treatments, treatments which have been proven ineffective, over science-based treatments that do work.
So although this Globe and Mail article wasn’t an all-out “Win”, it wasn’t a Fail either. But it does serve to bring up discussion about alternative medicine and the associated dangers of giving them more credit than they deserve.
Acupuncture has been around for a long time, most say around 4000 years. It evolved in China and has since become quite prolific in Eastern and Western culture.
Western medicine has been quite skeptical as to the efficacy of acupuncture, however. And with good reason. The scientific evidence does not support the improvement of conditions treated with acupuncture.
More accurately, no study has conclusively shown that acupuncture provides any added benefit other than the placebo effect. In fact, “sham” acupuncture, in which needles are placed at random places in the body, has been shown to be just as effective as “real” acupuncture. Hell, even just jabbing someone with a toothpick has demonstrated the same effect.
Traditional acupuncture is supposed to work by manipulating the body’s energy, the Qi (pronounced ‘Chi’). The Qi flows through the body in pathways known as “meridians”. When the energy flows are out of balance, this causes pain. By placing needles in the body at certain places in the body, the energy flow through the meridians can be corrected, and cure people of chronic pain.
This is a crock. You can’t blame people in 2000 B.C. for thinking that acupuncture would work this way, since they didn’t know any better. But people, this is 2000 A.D., and we know how the body works. And it doesn’t work this way.
But is it possible that this ancient explanation is wrong, but acupuncture could still work somehow?
Well this has been debated for a long time now. As I said above, evidence does not support the traditional practice of acupuncture, and most Western doctors are skeptical.
But there may be something more going on. When the body experiences pain, it releases pain fighting chemicals, such as endorphins. The same thing happens when we eat spicy food, and this is why we like it so much. The body feels the pain on the tongue and responds with a pleasurable release of endorphins.
It is conceivable that something similar could be happening during acupuncture treatments. But, is this truly “Acupuncture”? Does it really matter where you stick the needle? The current scientific evidence points to either just a placebo effect, or the same process occurring in both sham and real acupuncture treatments. Therefore, either nothing at all is happening, or it just doesn’t matter where you stick the needle or what type of pain stimulus you use. The effect is the same.
You may have heard about a recent study published in Nature. It seems that a neuromodulator called adenosine was released in mice when they received “acupuncture”. In this study, the scientists placed needles near the knee of mice in which pain was earlier induced in the foot. It seems that twisting the needles released the adenosine, causing a reduction of the pain in the mouse foot.
There are a few problems with the way this study has been reported. It is not acupuncture. They stuck the needles in the mice, and twisted them. The traditional practice of acupuncture has nothing to do with this study. Yet, the paper itself, and the way Nature is reporting it on their website, is that it is directly related to acupuncture, which is not the case. I find it disturbing that a prestigious, perhaps THE most prestigious journal in the world, would report the study this way. It complete and utter pandering.
The media touted this study as evidence that acupuncture works. But does it really? Does acupuncture have absolutely anything to do with mice? Certainly not in the traditional form of acupuncture involving the treatment of Qi.
My opinion is that acupuncture has nothing at all to do with this study. The pain stimulus could have been anything. Just because they used needles does not make it acupuncture, and certainly is not evidence that acupuncture works in humans.
At best, this study demonstrates a new method of controlling pain in the body in response to a stimulus. Which is interesting, but certainly not any sort of definitive proof that acupuncture in its true form, actually works.
Be careful with what the headlines you read, and even what the article states. It does not take an advanced science degree to note that what happens in mice, may not necessarily translate to humans. Particularly, when it comes to a 4000 year old supposed pain remedy designed specifically for humans.