This morning, as I read an otherwise informative and educational diary, I observed a bit of a derail concerning its topic. Anyone who was there, or is curious, can probably find what I saw. Since I have no interest in further pushing the train off the rails in a diary I liked, but I do have an interest in the placebo effect behind this 'alternative' medicine, it seemed best to find someplace new to express it.
I observed argument by authority -- doctors who use acupuncture, say, or naming studies (perhaps not actually tracking all of them down for a quote) that claim to have demonstrated this or that about acupuncture. I also observed some misunderstanding, perhaps, about what constitutes the placebo effect.
So, say a patient is injected with something they expect to be morphine and so they expect pain relief, which they get. What does it mean if it's found that the injection was mistakenly a shot of saline solution? That sounds like a placebo, like the classic 'sugar pill'. I observed users of acupuncture claim that what they're doing is not that for whatever reason. Does it make a difference if the acupuncturist is a doctor? Does being skeptical about it nullify the treatment? Not necessarily.
A common misunderstanding regarding placebos is that a placebo must be an inert substance that tricks the patient into thinking he's been given an active substance. This misunderstanding leads to the belief that the placebo effect is "all in the head." That is no more true than that people's physiological responses to what they think is alcohol or a drug are purely psychological. People can be conditioned to have physiological responses to placebos. Furthermore, Martina Amanzio et al. (2001) demonstrated that "at least part of the physiological basis for the placebo effect is opioid in nature" (Bausell 2007: 160). That is, we can be conditioned to release such chemical substances as endorphins, catecholamines, cortisol, and adrenaline. One reason, therefore, that people report pain relief from both acupuncture and sham acupuncture may be that both stimulate the opioid system. So can a lot of other things of course, like running a marathon, having an orgasm, eating habanero chiles, or getting a saline injection that you think is morphine.
I've heard of people showing signs of drunkenness after drinking
what they thought was alcohol, some time before it popped up in an episode of
Big Bang Theory. It's interesting to contemplate the apparent pain relief, for example, derived from acupuncture. Also the mention of
sham acupuncture. The article I read on the subject mentions the difficulty in coming up with a 'sham' acupuncture -- something that looks 'real' enough to make people think it is. But when studies go that far, the results can be
interesting.
One high quality acupuncture and pain study involved over 1,100 subjects with chronic back pain. Pain researchers often use the Von Korff Chronic Pain Grade Scale questionnaire and the back-specific Hanover Functional Ability Questionnaire (for back pain studies) to measure changes in back pain after various kinds of treatment. In this study the subjects were given different treatments and evaluated after six months using both the Von Korff and the Hanover instruments. The study compared treatment by (1) acupuncture using traditional acupuncture points and methods, (2) sham acupuncture that used non-traditional points and methods (the needles weren't inserted as deeply or twirled as in traditional acupuncture, and (3) treatment involving drugs, exercise, and physical therapy. About twice as many in the groups stuck with needles responded to the treatment as in the non-needle group. It did not matter whether the subjects were stuck in traditional points using traditional methods or in non-traditional points using non-traditional methods. About 45% responded in these groups compared to about 25% in the group treated with drugs, exercise, and physical therapy. According to the BBC:
The researchers, from the Ruhr University Bochum, say their findings suggest that the body may react positively to any thin needle prick - or that acupuncture may simply trigger a placebo effect.*
It might help to be a practicing doctor who also does acupuncture -- doctors have a reputation for sticking people with needles to make them feel better. But it takes more than an M.D. in front of a name to make what they do or say trustworthy. We've got folks like Ben Carson running for president, proving the point that skill as a doctor doesn't necessarily translate into wisdom beyond that skill-set. And there are alt-med proponents like
Dr. Oz out there, who advocates practices that ought to have his fans shaking their heads in embarrassment.
It may also help that much of acupuncture is about treating pain, which isn't necessarily easy to pin down. Much like catching a cold, pain can vary, it can go away unexpectedly at times. Most colds fade with time, regardless of what homeopathic remedy someone might have taken in the belief that it'd speed their recovery.
So, acupuncture might be effective, sometimes -- not with the reliability of an antibiotic, perhaps, but some. This doesn't make it any less of a placebo. Doctors and scientists have studied and continue to study it, because that's what scientists do. Health insurance companies have a financial interest in experimenting; every anecdotal report of a patient who dabbles in acupuncture and saved themselves expensive pain meds or costly surgery isn't just saving themselves some grief; they may be saving money for their insurance company, by using cheaper methods -- some "expert's" time and some needles, instead of a trip to the hospital or pricey pharmaceuticals. People suffering from chronic conditions and pain may want to try almost anything; if they have enough money, they'll go ahead and do it.
And that need for relief may well be the cause of the relief they experience.