Tag Archives: acupuncture

Dog acupuncture ? Seems a like a shaggy dog story

10 Dec

 

dog

Every so often I feel like newspapers are writing stories just to provide me with teaching materials and this week has given me  a beautiful example. On the 10th December the Daily Mail reported the story of a clinically depressed dog who had been cured by acupuncture. This story is almost perfect  for teaching rational thinking. From the headline alone one can generate a couple of interesting class questions:

How was ‘clinical depression’ diagnosed ?

Why might we me more inclined to believe in acupuncture than say homeopathy ?

Once one reads the whole story other questions emerge:

Was the dog’s ‘clinical depression’ a result of its physical injuries ?

Once the physical injuries were addressed would the ‘clinical depression’ have disappeared over a period ?

What evidence is there for ‘traditional chinese medicine’ ?

It seems perfectly reasonable to say that an abandoned and physically injury dog would suffer psychologically, but labelling this as clinical depression just seems ridiculous. One suspects that the method of diagnosis didn’t involve measuring serotonin levels, or indeed completing the Beck Depression Inventory. In relation to western views of ‘traditional chinese medicine’ I detect a reluctance on ‘cultural sensitivity’ grounds to be skeptical about acupuncture, and yet I read an interesting article recently that suggested that ‘traditional chinese medicine’ was a concept constructed by Chairman Mao to bypass China’s inability to deliver empirically tested Western medicine to its poulation !

Finally, this whole story seems to be to be an example of that old joke ‘Treatment X cured my common cold in seven days, and without it I would have had the cold for a whole week’. Once this dog’s physical wounds were cured we have no way of knowing whether his psychological ‘wounds’ would have healed without acupuncture, or indeed whether the undoubtedly caring treatment he received from the vet was effectively a placebo.

All in all, a lot of material from a simple story !

 

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Acupuncture and forgetting about the placebo effect

16 Nov

I’ve written previously about using acupuncture as an example for rational thinking, and last week I was drawn to the topic again by a series of newspaper stories about a study of the value of acupuncture in dealing with breast cancer related fatigue. A huge range of media outlets ran stories based on a paper published in the  Journal of Clinical Oncology on October 29th. The Daily Mail headlined their story ‘Acupuncture can relieve the extreme tiredness suffered by 40% of breast cancer patients”

At face value this study seems interesting, however as soon as you delve a little you find a major issue. The study compares acupuncture treatment with ‘no treatment’, there seems to have been no consideration of the placebo effect. A first sight constructing placebo acupuncture might seem difficult, however ‘sham’ acupuncture needles are available where the needle retracts into the handle rather than penetrating the skin, and studies have been conducted using such ‘sham’ acupuncture placebos.

In discussing drug trials with students they can rapidly see that the placebo effect needs to be considered. After all, no one would consider taking a drug that was no better than placebo. One would want to know that the drug actually ‘worked’. Yet with this acupuncture study we seem to being asked to accept a different standard of ‘proof’ than for more conventional medical treatment.

In addition to a discussion of the placebo effect this story could be used to illustrate a couple of more complex points. The idea that ‘alternative’ medicine should be subject to a different standard of ‘proof’ than ‘conventional’ medicine is an interesting one. Equally, the impact of this story on someone currently suffering from breast cancer related fatigue is also worthy of discussion.

Acupuncture as an example for rational thinking

11 Sep

I’ve written previously about using homeopathy as an example for discussing rational thinking, but in the last couple of days I’ve come across a couple of articles about another ‘alternative medicine’, acupuncture , that might be useful in getting to deploy higher-order rational thinking skills.

On Tuesday 11th September 2012, the Daily Mail reported a meta-analysis of acupuncture studies under the headline ‘acupuncture ‘does help to relieve pain’ say US researchers’. There is a certain irony, in that six days earlier the Mail had reported a story headlined ‘The hidden perils of acupuncture’, that detailed a range of cases in which NHS acupuncture patients had come to some harm including some cases of punctured lungs ! Irony aside, my interested was peeked by a quotation from original story, that has the studioes lead researchers saying:

”Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects’

As you might imagine, the Mail doesn’t enlarge on what ‘relatively modest’ means, but a brief bout of Googling led me to the Guardian’s version of the sample story that does list the size of the effects found:

Differences better actual acupuncture and sham controls

   Back and neck pain  .23  standard deviations

   Osteoarthritis            .16  standard deviations

   Chronic Headache   .15  standard deviations

So, in reality whilst this study did find that acupuncture did have some benefit beyond placebo in fact the benefits found were tiny. It’s interesting that whilst reporting of this study is widespread, from India (‘   Acupuncture proved effective for chronic pain  ‘) to the USA (‘Acupuncture may actual work after all’) very few of the articles bother to mention that the effect found were so small.

This little saga seems to provide a number of useful teaching opportunities. ‘How would you go about testing acupuncture’ is a great question as it lead to interesting discussion of the placebo effect and especially how you might create placbo acupuncture. Simon Singh and Edzard Ernst’s book ‘Trick or Treatment’ a great chapter on this. Beyond that, this story is a nice illustration of the importance of ‘looking at the numbers’ . Saying that this study showed that acupuncture ‘worked’ for back and neck pain, osteoarthritis and chronic headaches might be technically ‘true’, but without looking at the numbers you get no idea of how well they ‘worked’. For the statisdtcally mined this is a nice example of why students should always report significance AND effect size.

Finally, this story is another example of the importance of reading beyond newspaper headlines and where possible looking at the original source material.

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