The Opportunity Cost of Pseudoscience

Last month, the U.S. government-funded National Center for Complementary and Alternative Medicine released a study which found that Americans spent $34 billion annually on alternative medicine. Although this is just 1.5% of total health care spending in the country, it represents over 11% of all out-of-pocket expenditures. The report estimates that about 38 million adults visited alternative practitioners in 2007.

Unusually for a mainstream media outlet, the Boston Globe offers a much-welcomed skeptical perspective on this news, via a quote from Public Citizen which points out the important fact that most of these therapies are untested and largely unregulated:

Dr. Sidney Wolfe, who leads Public Citizen’s health research, has long criticized the government for what he considers lax regulation of prescription drugs and mainstream medicine. Yet, he also sees problems with the widespread use of dietary supplements.

“People think they are cleared” by the Food and Drug Administration, he said, when in fact they do not need proof of safety or effectiveness to go on the market.

“Mainly, they’re ineffective,” he said.

According to the NCCAM study, most alternative medicine spending goes to dietary supplements. Though supplements like fish oil and echinacea are massively popular, few of them have any clinically demonstrated effect, and even the ones that do contain active ingredients can vary dramatically in dosage and potency – which is, after all, what you’d expect from raw natural ingredients. The ability to isolate and purify the active ingredients found in nature, to deliver controlled doses at known potency, is the entire point of scientific medicine.

After supplements, some of the other alternative treatments mentioned in the study include acupuncture and homeopathy, both of which are useless placebos based on sympathetic magic and pseudoscientific theories about how the human body works. Another kind is massage therapy and chiropractic, which can be useful for some kinds of physical ailments but have nothing like the universal efficacy claimed by their more fanatical practitioners. Other therapies mentioned by the study include chelation, ayurvedic medicine, and “energy-healing therapy”.

I can only view these figures as a massive missed opportunity. Not just a missed opportunity to educate the public about why we should rely on evidence-based medicine, although it’s certainly that. But more than that, it’s a societal failure: a misallocation of society’s resources on an enormous scale. Just think what that $34 billion could have done if it were put toward genuine scientific and medical research – how many promising studies could have been funded, how many discoveries made, how many diseases potentially cured! (For comparison, the entire 2010 budget request of the National Science Foundation is only $7 billion.)

Obviously, there’s no direct tradeoff here. Even if all Americans decided to reject alternative medicine, these funds wouldn’t necessarily have gone to scientific research. Much spending on alternative medicine is for conditions that are still poorly understood or that have no effective treatment, since these are always the areas where pseudoscience springs up. What we’re seeing here is an opportunity cost: the price we, as a society, pay for the decisions we collectively make about how to allocate our resources. Money that we spend on alternative medicine and other pseudosciences is money that we can’t spend on areas that might genuinely improve our lives.

About Adam Lee

Adam Lee is an atheist writer and speaker living in New York City. His new novel, Broken Ring, is available in paperback and e-book. Read his full bio, or follow him on Twitter.

  • http://www.myspace.com/driftwoodduo Steve Bowen

    Ebon
    The flip side of this is the assumption that all conventional medicines are as effective and as safe as claimed. Also there is an increasing tendency for big pharma to attempt to pathologise symptoms which may be just a natural part of the human condition (mild depression, tiredness, age related aches and pains etc)and many “natural” supplements are taken as a first recourse for these. I must admit to being a bit of a sucker for some of these myself although I limit my intake to supplements that have had some indicative studies done (Omega 3, Ginko, Echinacia). I guess the rational thing would be for proper double blind clinical trials to be done on food supplements and the FDA (or NICE in the UK) to approve them in some way.
    I do however take your point entirely when it comes to homeopathy, bach flower, reiki, acupuncture etc etc ad nauseum.

  • http://friendlyhumanist.blogspot.com Timothy Mills

    Keep in mind that many alternative medicines are produced by the same companies that have rightly earned the epithet “big pharma”. (I’m getting this from Ben Goldacre’s excellent book, Bad Science, in which he is at least as vocal in his condemnation of big pharma as he is of homeopathy and other alternatives to real medicine.) Homeopaths and the like pathologize symptoms as much as pharmaceutical companies do – they just claim a different sort of magic pill to be the solution.

  • http://friendlyhumanist.blogspot.com Timothy Mills

    Ebon, the first paragraph after the Globe quote ends with an unfinished sentence. Just FYI from someone who is interested to read the rest of that thought.

  • http://she-who-chatters.blogspot.com D

    For a lot of people, the way they go about making medical decisions has too much by far to do with completely non-medical issues. Health care in general is a huge bag with a whole bunch of things in there that “don’t belong” and make it harder to know and do the right thing.

    For instance, some people can feel alienated by the “depersonalized” feelings they get from “mainstream” (read: “legitimate”) medicine. In the office of an “establishment” doctor, who is busy trying to help as many people as she possibly can, a patient may feel he is receiving poor care because he doesn’t get as much attention from this doctor as he does from his homeopath neighbor. And if what he’s feeling is a general malaise from “the whole big whatever of it all” (y’know, one of those vague phrases that doesn’t really tell you anything), then getting personal attention is just what he needs and he’ll convalesce on his own.

    Keep in mind that the homeopath didn’t do anything effective as a homeopath; what this man needed was to feel doted upon by some authority figure. He didn’t need medicine, he needed mothering. I say people like this need to either grow up or seek therapy; but growing up means you don’t get mothered any more, and there’s a stigma associated with psychological therapy that prevents many people from getting good help thereby.

    Your point on opportunity cost is a very good one, and anyone who has one of those “can’t hurt, might help” attitudes could stand to learn a thing or two from it. I completely fail to see how funding quacks and sowing confusion in the marketplace doesn’t hurt, and how placebo effects are counted as “help” when they are a product of the patient’s mind and not of the pseudoscience treatment in question. Argh.

  • http://www.blacksunjournal.com BlackSun

    Talking about “Big Pharma” in response to quackery is a textbook example of the “tu quoque” fallacy. No amount of corruption by the pharmaceutical companies could have any bearing on the lack of effectiveness of useless “alternative” therapies. It’s a separate issue.

    And it doesn’t matter that a homeopath might be a nice guy or a better listener than a medical doctor. This doesn’t mean they’re any less of a fraud. Even if they are sincere they are still a fraud. And the MD is still an MD. The placebo effect is still the placebo effect.

    I agree with D. Why is this so hard?

  • thinkoplex

    I think that a lot of people turn to alternative treatments because legitimate medicine is not really an option for them. Do not forget that a substantial number of Americans lack health insurance, and this is often a barrier to admission at hospitals or private medical offices even if they could afford the visit (though they might not be able to afford subsequent visits). Effective prescription medicines are then unobtainable because they require a visit to a doctor who can write the prescription.

    The sellers of alternative medicines – often big pharma themselves, as pointed out above – make grandiose claims about the efficacy of their products which promise an alternative to a treatment regimen that these individuals simply could not afford to pay for. This is amplified by a section of society that truly believes in the miraculous powers of homeopathy, acupuncture, and other forms of magic; to a desperate and uninformed consumer – and, in some ways, we are all uninformed – these promises are worth the relatively small individual cost of exploring.

  • http://www.1in7billion.com Bechamel

    I always have to wonder about that $34 billion number, given all it includes. My father has a bad back. He goes to a chiropractor from time to time, and the adjustment usually relieves his back pain for a couple of weeks. I will occasionally go to a massage therapist, not to heal anything, but because massages feel good. And as far as I can tell, just because some practitioners in these fields grossly overstate what their services can do, they all get lumped into “alternative medicine”.

    I realize it’s probably a tiny drop in the bucket, but seeing a number that includes a portion of my (and others’) spending on recreation/self-indulgence (and others’ genuine pain relief) toted out as “here’s how bad the woo is” just leaves a bad taste in my mouth. Am I just oversensitive?

  • exrelayman

    This is a worrisome topic for me. I take nattokinase and hisbiscus flower herb and they brought my blood pressure down from 140/90 to 120/80. I take a multi pronged supplement for arthritis and have increased function and reduced pain. I take a number of food/vitamin supplements to compensate for poor dietary practices (I am willing to die – just not willing to eat broccoli et al).

    Of course to many my result is anecdote and possibly placebo. For me eliminating access to supplements would surely increase suffering and reduce lifespan.

    There is good and bad in the supplement field. One of my rule of thumbs is that good reports about a supplement must come from multiple sources, not just from the seller of same or alleged satisfied customers. In all likelihood there are some things I take that are worthless or harmful in spite of my sifting of evidence.

    I concur that alternative therapies are mainly bunko, but hope to not lose supplements that help me due to overzealous restrictions. Just my $.o2 worth.

  • Entomologista

    Exrelayman, nobody wants to take away your vitamins. All we’re asking for is some research to figure out how and why (if) things like hibiscus work. And then some regulation so you aren’t poisoned by unsafe concentrations.

    And chelation? That will kill you stone dead unless you’ve got heavy metal poisoning.

  • http://she-who-chatters.blogspot.com D

    Bechamel, you’re not being oversensitive; you have a legitimate concern about what is known as “confounding variables.” Getting a massage because it feels good is fine, but getting it from a person who also has delusions of efficacy beyond the simple relaxing pleasures of a backrub complicates the matter. Yes, you are funding someone who behaves, at times, like a quack. Yes, your contribution is hard to separate as “fun money” from the “woo money” of people who overestimate the healing power of touch. If the quacks all bottomed-up overnight, I’m betting that money you spend on massages would simply be spent on a different masseuse or masseur, and would not go to funding research or whatever. Lacking any principled way of further contextualizing the data, the principle of charity dictates that we should work with the claims as presented, but with a grain of salt. I think that even with a heaping pile of salt, Ebon’s point stands solid.

    Careful, exrelayman: you should try saying, “I took supplements X, Y, and Z, and then my blood pressure dropped,” instead of, “I took supplements X, Y, and Z, and they caused my blood pressure to drop.” Human health is a Gordian knot of metabolic pathways and such, so without some extensive double-blind trials to justify a belief in a causal relationship, what you have is anecdotal. Since you are the anecdote, and it’s your money and your health, you can do what you like. Really. Just keep the limitations of your own experience in mind when you talk about those experiences (you are, in terms of argumentative weight, only one trial among many). Entomologista’s right that nobody wants to take away your supplements; we just want to have transparency when it comes to the claims made by manufacturers about said supplements, and it sticks in our craw when they get undue credit.

  • Paul

    D,

    The response to Bechamel isn’t as simple as that.

    Not all massage parlors claim to give you anything more than a pleasant sensation. Yet they still get lumped in when polls are taken on CAM. It’s one of the confounding factors that get deliberately added in to CAM to deceptively grant it a lustre of respectability, much the same way that they coopt diet and exercise and claim the good results that follow in the name of CAM. It’s not just that not every customer thinks they are getting medical care, but not every provider believes or advertises that there is any medical benefit (this also applies to chiro, no distinction is made between those that only help with back pain and those who claim to cure childhood asthma). Yet no distinction is made.

    Short version, you’re the one making a leap when you’re assuming that Bechamel’s masseuse has delusions of efficacy beyond giving a nice back rub.

    Still, I agree that Ebon’s point is solid. It’s just a matter of sloppy numbers, but that is not his responsibility. I mean, it’s not his fault NCCAM includes massage, pilates, yoga, and tai chi as “alternative medicine” when that’s not generally what they are sold as (and no effort is made to see if the people polled considered them such, they are simply asked if they have seen a practitioner or teacher in the last 12 months). The numbers can give us an idea of sheer volume, and it is pretty staggering (for example, 12 billion alone went to “nonvitamin nonmineral natural supplements” i.e. herbal supplements).

  • http://www.patheos.com/blogs/daylightatheism Ebonmuse

    I’ve fixed the post to include the rest of the missing sentence in the third paragraph.

  • http://paulsoth.livejournal.com Paul Soth

    The site What’s The Harm? keeps a listing of deaths and other misfortunes that have been caused by alternative medicine and other forms of pseudoscience, superstition, and a general lack of critical thinking. The homeopathy section alone is quite sobering, with a number of the victims include infants.

  • http://www.WorldOfPrime.com Yahzi

    I saw Dr. Rhelman debate Andrew Weil at the UofA many years ago. Dr. Weil was recounting a story about a man with scolerma who was cured after rubbing lemon juice all over his body.

    Dr. Rhelman interrupted to ask, “But Andy, did the patient get better because of the lemon juice?”

    Dr. Weil responded, somewhat testily, “I don’t know. I just know he got better.”

    Dr. Rhelman turned to the audience, spread his hands, and said, “I rest my case.”

    Sadly the debate went on for another hour, but there was no point. Even more sadly, the audience – despite sitting in the auditorium of a teaching hospital – did not get up and walk out after Rhelman ended the debate with a crushing victory. In fact, Weil went on to head up UofA’s alternative medicine clinic…

  • Ritchie

    Whilst I do agree that most alternative therapies are probably placebos, a sad point is that placebos often DO work. Maybe it is the attention, as D pointed out. If the problem you are trying to treat is phychological, then placebos may be even more effective, as attitude obviously plays a huge role in how you judge your mental well-being. So I can understand that there is a place for such ‘Placebo Therapies’.

    That said, $34 billion is pretty shocking.

  • exrelayman

    D – I understand that B following A doesn’t mean A caused B. As one person seeking to lower my blood pressure without the harsh side effects of most conventional pharmaceuticals, I have tried several things which did not have any effect before arriving at 2 supplements which did have an effect. Not being able to do double blind, every such test was meticulous in isolating the change in my diet and lifestyle to only the new supplement. If the effect is placebo (it may indeed be, recall I used the words placebo and anecdote in my first comment) I am curious as to why my mental nature did not get the placebo effect on the supplements which failed to help. However, I particularly wanted to comment as my viewpoint is not quite the party line about pseudo-medicine. Would like to just mention that one of my relatives succumbed to cancer after undergoing quack treatment, so I am generally quite on Ebon’s side of the fence on this issue generally.

    Please bear in mind that conventional medicine is not much interested in supplements for people who stubbornly refuse to eat right so I have had to go it on my own, however unscientifically. (I know, I know, a doctor that treats himself has a fool for a client. (No claim to be a doctor))

    Now a question perhaps some one of greater scientific training than me might address. Is not placebo effect understood well enough so that if a medicine or supplement is being tested for alleged beneficial effect that all the subjects tested could take it, and the results be compared to the expected placebo effect for statistical variation? I understand that should it have a harmful effect this method might cause more harm, but on the other side of this, if it should have a beneficial effect double blind will deprive the placebo pill group of its benefit. Anyone care to elaborate on this, how these considerations offset?

  • http://whyihatejesus.blogspot.com/ OMGF

    Placebo effects are taken into account by using a control group that receives a placebo. If the drug in question has a measurable effect, then it should show in greater efficacy verses the control group which receives the placebo.

  • Chet

    Is not placebo effect understood well enough so that if a medicine or supplement is being tested for alleged beneficial effect that all the subjects tested could take it, and the results be compared to the expected placebo effect for statistical variation?

    We don’t know how to “expect” what the precise placebo effect for a given application will be. Some conditions or illnesses have zero placebo effect. Some conditions are subjective, like the experience of aches, pains, and nausea for example, and so the placebo effect can be strong, because you alter your perception of your own pain to fit your preconception that you’re “recovering.” Some things just go away on their own – even cancer.

    That’s why double-blind studies are done, where “double-blind” means that neither the patients nor their immediate medical supervisors know if they’re on the placebo or the treatment.

  • John Nernoff

    I recommend all of you participants to go to the “Quackwatch” website where all these scams are listed, and where you can sign up for a discussion group e-mailing which keeps you up to date on the latest nonsense in “alternative medicine.”

    http://www.quackwatch.org

  • Scotlyn

    Ebon, you’ve smoked me out. I am, if you can accept that such a thing is possible, an evidence-based acupuncturist. I will proceed to briefly lay out my case, and hope that the people I’ve come to know and appreciate here will take it under consideration before hounding me off this site as a quack.
    The first question regarding all therapeutic interventions is efficacy. The reviews of efficacy studies for acupuncture in the Cochrane database beginning to accumulate. This one has a fairly typical result, so I’ll quote it in full: Six trials investigating whether adding acupuncture to basic care (which usually involves only treating acute headaches) found that those patients who received acupuncture had fewer headaches. Fourteen trials compared true acupuncture with inadequate or fake acupuncture interventions in which needles were either inserted at incorrect points or did not penetrate the skin. In these trials both groups had fewer headaches than before treatment, but there was no difference between the effects of the two treatments. In the four trials in which acupuncture was compared to a proven prophylactic drug treatment, patients receiving acupuncture tended to report more improvement and fewer side effects. Collectively, the studies suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists. Note that, as is often the case, acupuncture was found to be better than “basic care;” better than “before treatment;” and even better than “proven prophylactic drug treatments.” Nevertheless, “the correct placement of needles seems to be less relevant that is usually thought by acupuncturists.” This type of result is extremely common, and often interpreted as meaning, “acupuncture is no better than a placebo.” However, it is also possible that it means that an effective acupuncture placebo has not yet been discovered – that is to say, a procedure that would feel to the person receiving it exactly like acupuncture, yet having no physiological effect whatsoever. There are other problems with applying an RCT model to acupuncture, in that it is not like a medication where dosage is standardiseable. It is a skill which varying practitioners will have to varying degrees – more like surgery. And like surgery, it is difficult to figure out how to blind the practitioner – who must necessarily know whether the procedure they are implementing is their “real” one or not. In 2005, a panel of researchers agreed the STRICTA protocol for improving the quality of acupuncture research, to deal with these and other difficult issues.

    The second important question relating to all therapeutic interventions is biological plausibility. In acupuncture, the needle is presumed to interact with something called “qi” which you have written about before, Ebon. Personally, I think the current research on small physiological electric fields by, for example, the research team of Colin McCaig and Min Zhao of Aberdeen, will prove to be illuminating. Properly trained acupuncturists, when palpating, locating and needling acupuncture points (more properly translated from the Chinese as “dynamic holes”), know that the key for effective treatment is to needle what feels like “empty” spaces. Obviously, they are not “empty” as such – they are spaces filled with interstitial fluid – but, as the classics emphasise, they are not in muscle, skin, sinew or bone. (The common fallacy that they are located in nerves can easily be discounted by observing the way in which our patients do not instantly jump off our treatment table and run away!) The interstitial fluids of the body are filled with charged ions, and are therefore capable of developing electrical properties which are modifiable with needles of various metals. It is only a small step to conceive of the interstitial fluid-filled spaces of the body as being capable of sustaining small, but measurable – given sensitive enough equipment – electrical flows from areas of greater resistance to areas of lesser resistance, and that such flows might aggregate into streams such as those known as acupuncture channels. Such flows would not create any discernable anatomical structure, but would be defined solely by movement of the traffic itself – something like a flightpath – which cannot be photographed. One early paper attempting to define acupuncture points by their electrical properties is found here. And now I’ll stop and wait for the flack – although I could go on, if anyone is genuinely interested…

  • Scotlyn

    My very last link failed, so try here.

  • Chet

    However, it is also possible that it means that an effective acupuncture placebo has not yet been discovered – that is to say, a procedure that would feel to the person receiving it exactly like acupuncture, yet having no physiological effect whatsoever.

    I’m sorry but I find that a little convenient. And consider this – if it’s true that acupuncture is no more effective than jabs in the back with wooden toothpicks, and it is, then there’s really no compelling reason to prefer an expensive, highly-trained acupuncturist to someone with a box of toothpicks. Another way to look at it is, why doesn’t training in acupuncture work? Usually when people are trained in something real, they get better at it. But apparently any lab tech with a box of wooden sticks is every bit as good. That’s a little suspicious, isn’t it?

    know that the key for effective treatment is to needle what feels like “empty” spaces.

    The evidence suggests that this is not key at all; that it’s not even necessary to pierce the skin. That it isn’t necessary to use metal needles at all; merely the false sensation of needles is sufficient to produce the same results. By the mechanism you’ve outlined here that certainly qualifies as “psychological but no physiological effect”, so I would say your conclusion about acupuncture having no suitable placebo has been refuted.

    I don’t think it’s possible to be an evidence-based acupuncture proponent because the evidence is pretty clear that the benefits of acupuncture are all in your head, that it’s no better than an appropriate placebo.

    It is only a small step to conceive of the interstitial fluid-filled spaces of the body as being capable of sustaining small, but measurable – given sensitive enough equipment – electrical flows from areas of greater resistance to areas of lesser resistance

    This is not at all how electricity works. Electricity flows from areas of greater charge to lesser, not greater resistance to lesser.

  • http://www.patheos.com/blogs/daylightatheism Ebonmuse

    Sorry, Scotlyn, but I have to agree with Chet. Clinical studies of acupuncture have found that it doesn’t matter where you insert the needles, or even if they actually penetrate the skin. You yourself cited that result. That’s the definition of a placebo.

    And what really raises my skeptical hackles is that the original justification for acupuncture – that the needles affect the flow of chi in the body – is pure superstition, not based on any true statement about how the body works. The idea that needles might affect physiological electric fields strikes me as a post hoc rationalization, contrived by researchers once they realized the chi explanation was untenable. Again, if that was how acupuncture worked, how would you account for the fact that people being poked in the back with toothpicks also experienced pain relief?

    Now, if people who got real or sham acupuncture reported feeling better than people who got the standard drugs for headaches, that would be something worth looking into. But that’s not necessarily a proof that acupuncture is effective; it could also be a proof that standard headache drugs are ineffective. Certainly, it’s not controversial that chronic pain is one of the conditions we’re not that good at treating, and it’s also not controversial that placebos have their strongest effect on conditions like nonspecific pain.

  • Scotlyn

    Chet, I absolutely accept your correction re: “charge” vs “resistance.”

    Essentially, the “toothpick” study you point out, and its results, are similar to those of the study I quoted – both are quite typical. And my point remains the same.

    It is difficult, in the extreme, to “blind” an acupuncturist. (How do surgeons cope with this problem when testing the efficacy of surgical procedures?) It is almost as difficult to “blind” a patient, unless they are (as the study you quote states) “acupuncture-naive”. Both of these “blindings” are essential in order to construct a proper double-blind RCT. It is also difficult to deliver acupuncture in a “standard dose” – it is not a drug. (Again, how do surgeons cope with this problem when subjecting their procedures to evidence-based testing?)

    The question of what constitutes a proper acupuncture control is a highly vexed one. As the commenter you quoted pointed out, “no treatment” does not constitute a placebo control, although it can still be a useful study control, because the subjects who are not being treated definitely do not suspect that they may have received acupuncture. Various control procedures have been used to date with the aim of persuading people that they have received acupuncture without producing any physiological effect – including toothpicks twirled against the skin, a patented device which appears to depress a needle through a guidetube without actually inserting it, real needle insertion at non-acupuncture points, real needles inserted at “real” points more shallowly, etc.

    If the acupuncture mechanism for producing measurable changes in various physiological processes is produced by the induction of electrical changes in the interstitial fluids of the body, which is present in every part of the body, (as seems at least plausible) then these effects may be produced in a number of different ways, including non-penetrating stimulation such as that obtained with toothpicks. This needs further study, and until it is clear that these different forms of stimulation have no physiological effects, then their use as a placebo control is also suspect. All of these issues make acupuncture efficacy studies both difficult to conduct, and to evaluate.

    This is not to say that we shouldn’t conduct them – in fact, we owe it to our patients to continue to struggle with and resolve these inherent problems – which is why I am a fan of the STRICTA protocol – see above – and other initiatives aimed at putting better research on the table.

    The difficulties inherent in the RCT model for researching acupuncture that I have highlighted are not due to any special pleading. Note, I don’t argue that acupuncture is too mystical or that it is based on some ineffable ancient wisdom that means it should not be tested (because such views are nonsense). The difficulties I have highlighted here would be shared by many non-drug aspects of medicine. How useful is the the RCT model for evaluating the evidence base for surgery? for palliative nursing? for physiotheraphy? for psychotheraphy? Perhaps, as we speak, better minds than ours are coming up with ways of evaluating these.

  • http://whyihatejesus.blogspot.com/ OMGF

    If the acupuncture mechanism for producing measurable changes in various physiological processes is produced by the induction of electrical changes in the interstitial fluids of the body, which is present in every part of the body, (as seems at least plausible) then these effects may be produced in a number of different ways, including non-penetrating stimulation such as that obtained with toothpicks.

    Wood does not induce electricity or current, whether it is inserted into a charged space or merely waved over it.

  • Scotlyn

    And what really raises my skeptical hackles is that the original justification for acupuncture – that the needles affect the flow of chi in the body – is pure superstition, not based on any true statement about how the body works. The idea that needles might affect physiological electric fields strikes me as a post hoc rationalization, contrived by researchers once they realized the chi explanation was untenable.

    Ebon, I certainly can understand how you have come to the conclusion that the “flow of chi in the body – is pure superstition, not based on any true statement about how the body works.” And the case is certainly not helped by all your “ancient wisdom is far superior to the modern sort” types who do not believe evidence has any relationship to knowledge.

    I should state clearly, though, that the idea that the classical concept of “qi” and the measurable natural phenomenon of endogenous physiological electrical fields – see the McCaig/Zhao link above – (that is to say, a “true statement of how the body works”) might be one and the same thing is my own. I do not know if any other researchers have come up with this idea – whether to prop up failed research or otherwise. I personally am not equipped to do this research myself, I am only in a position to observe what happens in my own clinic, and read as widely as possible and ponder. What I know is that when I discovered the electrical field research it explained a lot for me personally.

    As did reading up on recent research on the crucial 100 years or so (between the closing of the recently excavated Ma Wang Dui tombs in 168BC and the likely date of the publishing of the “ling shu” – the original classic of acupuncture – in or around 60BC). The medical texts discovered in the Ma Wang Dui tombs do not contain any reference to acupuncture points or to any needling technique other than lancing a boil. Nevertheless, they do contain extensive references to self-cultivation techniques similar to modern day Tai Chi or Qi Gong. They also contain drawings of acupuncture channels. It is not unlikely that the discovery of the flow of “qi” in channels was an internal discovery that followed such cultivation techniques (and which can be re-discovered by anyone willing to put in the time to undertake a regimen of Tai Chi or Qi Gong training).

    Acupuncture as a technique for interacting with the electrical flow in the interstitial fluids seems to have developed within the 100 years or so between 160 BC and 60 BC. It may turn out to be a crude technique, in comparison to finely tuned techniques of the future, once this phenomenon is better studied and understood.

    Nevertheless, as it stands it has some very useful clinical applications – for example, there are many patients who suffer a lot of pain and do not tolerate analgesic drugs very well. In my personal practice, I work closely with local medical doctors who are happy to refer relevant cases to me. Likewise, I do not consider my practice an alternative to theirs, and in many cases refer my patients straight back to their GP’s for further medical diagnosis, investigation and treatment.

    In relation to this thread, Ebon, even if nothing I say convinces you of the merits of acupuncture, I will be happy so long as I can convince you that my own researches into the physiology, history and practice of acupuncture, coupled with my experience in the clinic, have convinced me personally (as well as the local GP’s I mentioned earlier) that there is evidence for its use and that I personally am not in the business of parting gullible people from their money. (In fact, quite the opposite, on that last one – my senior citizen rates are well within the reach people solely sustained by their old age pensions)… and on that note, I’ll rest and give you back your thread. Apologies for the lengthy offerings.

  • Scotlyn

    Ok, one more –

    Wood does not induce electricity or current, whether it is inserted into a charged space or merely waved over it.

    Wood does not produce electrical effects, but pressure does – this phenomenon is known as piezoelectricity. “Appearance of an electric field in certain nonconducting crystals as a result of the application of mechanical pressure. Pressure polarizes some crystals, such as quartz, by slightly separating the centers of positive and negative charge. The resultant electric field is detectable as a voltage.”

  • Fred

    Everyone here defending alternative medicine needs to read the excellent article by Barry Beyerstein on “Why Bogus Therapies Seem to Work”:

    http://www.csicop.org/si/9709/beyer.html

  • http://effingtheineffable.wordpress.com Peter Magellan

    Wood does not produce electrical effects, but pressure does – this phenomenon is known as piezoelectricity.

    Piezoelectricity is restricted to certain crystalline materials, as you point out. Human flesh is not one of them. If it was, we would inhabit a very different society… ;-)

  • http://whyihatejesus.blogspot.com OMGF

    There’s a reason that it’s restricted to crystalline materials as well, in that the effect is dependent on the regularity of the crystalline structure. The interstitial fluid does not have this regularity.

  • Thumpalumpacus

    Whether it works or not, ain’t no one gonna poke me with foot-long needles, or else they too will develop an acute need for pain relief.

  • exrelayman

    Just a word of thanks to Chet and OMFG for patiently informing my ignorance without condescendingly suggesting that I google ‘placebo’ or ‘double blind’, which I did not think of while commenting but will now do.

    Another late thought I had about what is wrong with my proposed absurd statistical test is that the risk of greater harm versus the risk of not receiving the benefit is properly assessed by the adage ‘first do no harm’.

    Further thanks for the links provided by others on this topic.

  • Scotlyn

    Peter

    Piezoelectricity is restricted to certain crystalline materials, as you point out. Human flesh is not one of them. If it was, we would inhabit a very different society… ;-)

    The piezoelectric properties of “human flesh” – more specifically collagen (abundant in all connective tissues), bone, the cornea of the eye and other “fleshy” tissues are covered here, here, here, here, and here, among the many, many results for a search “piezoelectric” and “human tissue” in Google Scholar.

    “The piezoelectric effect was measured in samples of human bone and repeated with the same samples after either demineralization or decollagenation. The results indicate that at least part and possibly all of the piezoelectric effect found in whole bone arises from the organic component. The existence of two alternatives results from the unknown role of the collagen-mineral interface. In either case, bone mineral per se makes no contribution to the piezoelectric effect in bone,” according to the abstract for the pay-per-view article here.

    This study of a new imaging technique expects to deliver interesting results “Because of the ubiquitous presence of piezoelectricity in biological systems, this approach is expected to find broad application in high-resolution studies of a wide range of biomaterials.”

  • Scotlyn

    PS – the piezoelectrical properties of bone and connective tissues account in no small way for the ability of work, exercise and other mechanical stresses to be translated by the cells into instructions to thicken bones and build up muscles.

  • http://cranialhyperossification.blogspot.com GDad

    Would this scenario approach double-blind testing for acupuncture?

    Patient is put under general anesthetic.
    Acupuncturist delivers acupuncture treatment OR technician delivers faux treatment.
    Patient is interviewed after waking up by a person who is unaware of which treatment was given.

    I’m not sure about running a test that requires patients to go unconscious. Not sure if ethics standards are violated, but then how do they test anesthetics?

  • Scotlyn

    Gdad – interesting suggestion. As a study design, it would certainly help “blind” the acupuncturees – you would not even need to use a “faux” treatment, just a “no treatment” arm, as the subjects would not know when they woke, if they had been acupunctured or not. The acupuncturist, of course, would not be able to be “blinded” – so, as a design, such a trial would be very similar to this one conducted on a surgical procedure known as arthroscopic debridement of the knee vs placebo.

    On ethical grounds, I suspect this study design would not pass. Anaesthesia is, of itself, quite hazardous, and poorly understood even yet, and is generally used sparingly on humans in test situations. I personally would be reluctant to endanger someone’s life by anaesthetising them – my own sister nearly died of a rare allergic reaction to an anaesthetic – and lest you take that as a so-called “CAM-style” criticism of “bad old Western medicine”, may I point out that my family is eternally grateful and indebted to the skills and quick reactions of an anaesthetist who had, just once before in his professional life, seen “malignant hyperpyrexia,” and knew how to save her life.

    The ethics of the lab are somewhat different, so acupuncture – specifically electroacupuncture – has been carried out on anaesthetised dogs and rabbits.) The second study, in particular, evaluated whether different substances either antagonised or potentiated acupuncture. Altogether over 18 different substances, including naxolone and certain classes of serotonin inhibitors have been found to antagonise acupuncture effects in lab animal models.

  • Scotlyn

    I personally have no research funds, whatsoever, but my personal idea of a useful study design would be to randomly allocate people with a condition being studied to either an actor or an acupuncturist. The actors would need to be given training in clean needle technique and safety, and where not to needle (to avoid pneumothorax and other such hazards – probably safest to stick to arms and legs) and they would need to be allowed to practice the technique of “sticking a needle in anywhere” for a few days to build up their confidence and reduce the painfulness of their technique, as well as looking like they know what they are doing. They would be allowed to observe real clinical acupuncture sessions from a distance – to absorb the general atmosphere and feel of what takes place there, so they can replicate it. However, prior knowledge about acupuncture, especially about the locations of acupoints and channels or their use, would disqualify them from taking part. The actors would be able to give the warm impression of listening, caring, etc, that is supposed to provide the main benefits of acupuncture, but they would be sticking whatever complement of needles they’ve been given (usually 8 or 10 per patient) just anywhere at all – although it would be safest, as I said to restrict them to arms and legs in order to avoid needling anything dangerous. Both the actors and acupuncturists could have “supervisors” standing by, in order to make the settings as identical as possible, but in the actors’ case, the supervisors would be standing by in case of any adverse events.

    Again, I don’t know if this would be ethical, but, as “sham” acupuncture, whether with toothpicks or needles is usually applied by trained acupuncturists who want to make people better, (and not lab technicians) and may have the subconscious desire to apply their training to do so, using completely acupuncture-naive practitioners might provide a better control for trial purposes.

  • http://whyihatejesus.blogspot.com OMGF

    Piezoelectricity:
    It seems that collagen holds a crystalline component named micelle that allows for some piezoelectricity (an order of magnitude lower than crystals such as quartz) but this lends no support to the idea that interstitial fluids have anything to do with it. Fluids do not align like crystals, meaning that there can be no piezoelectric effect, since the effect depends on that repeating structure to work. The charge inequality that arises from mechanical pressure can not occur in a liquid, because the molecules are free to re-orient themselves, which effectively will negate any charge inequality. This is why researchers doing bone studies have had to dry the bones out in order to see the effects.

  • Scotlyn

    OMGF – thanks for stimulating me to do more reading and research – this: “Chapters
    4-6 show that phospholipids that occur naturally in biological membranes are
    piezoelectric and the piezoelectricity is caused by molecular chirality. This could have major biological implications” is hot off the presses here. But I haven’t got time to stop to argue – there is some really fascinating material for me to dive into and get familiar with.
    Take care – S

  • http://whyihatejesus.blogspot.com OMGF

    Scotlyn,
    Thanks for expanding my knowledge. I did not know that piezoelectricity could be found in such a variety of materials.

    I understand that you believe that acupuncture works, and that you’re willing to put it to the test, which is a good thing. We should test these claims and see if they have any merit. I think that’s all any of us are really asking for.

  • Scotlyn

    OMGF – In short, acupuncture is the single treatment modality currently outside of what is known as “medicine” that has a very high approval rating among medical doctors. Ted Kaptchuk, a medical doctor who took an active interest in acupuncture in the 70′s and has maintained it ever since, attributes this to the fact that, although the efficacy tests (RCT’s) are most often inconclusive, or insufficiently positive to be meaningful, there are a host of physiologically measurable effects that have been elicited by acupuncture in lab animal studies and in human volunteers. A couple of examples would include increases in cardiac volume, neurological effects that can be viewed under fMRI, and many others. Some chemical substances measurably antagonise such effects, and a very view appear to potentiate them. The physiological route between the stimulus and the effect, however, has not yet been elicited with any certainty.

    I personally am not at all knowledgeable about such matters, but I do my best to keep up. And I suspect that the “route of action” will turn out to have something to do with the nature and structure of connective tissue, and electrical effects that diffuse or propagate via the interstitial fluids. There are many ways in which the body is “electric.” Our fluids are filled with electrolytes which produce various dialectric effects. Bones have both piezoelectric properties (which are maintained to a certain extent with typical hydration levels of 26%) and streaming potentials. Water actually helps the cornea of the eye to become more crystalline. The phospholipids that make up every cell membrane in the body share some properties – including the piezoelectric effect – with liquid crystals.

    The last thing I’ll offer is, I know, the least persuasive thing in my argument, but nevertheless…if I return to Ebon’s comment about “superstition” you could think of it this way. If someone told you, “watch this person’s chest going up and down rhythmically – that is the comings and goings of their soul. When you see someone die, and you see that rhythm stop, you have just witnessed the departure of their soul.” The thing is that you can separate the components of that statement – the “soul” aspect of it is superstition. But you don’t say that the person can’t be breathing because that is “just superstition.” You keep the part of the statement that refers to something real and observable. And in my practice I do actually observe that there is a movement, through the body, of “something” that circulates constantly and everywhere, but is separate to the circulation of the blood. When blocked at some point in it’s flow, “upstream” effects (pain, redness, swelling, and in the long, long term, rigid hypertonic muscles) and “downstream” effects (numbness, cold, and in the long, long term flaccid, weak hypotonic muscles) can be forensically discovered. The esoteric language of Chinese Medicine can be picked through for concepts that work in the clinic – the channel system happens to be one that works. For me, that is the real, physiological manifestation that can be separated from its mystical trappings and put to good use.
    As to the claims I make, they are small. I do not consider my practice to be an “alternative” to medicine. I think it is a complement, like physiotherapy, that may eventually find its rightful place there. I do not encourage my patients to think of anyone but their own GP as their primary care person. I do consider acupuncture to be indicated where there is a “localisable” problem – a channel problem, in other words. I think the reasons for this – and perhaps better ways of using it, will emerge from further research. But once again, thanks, my reading has been pretty interesting over the past few days!
    Ebon – apologies for my lengthiness. I couldn’t let this subject go without “coming out” on it – it has been less painful than I thought.

  • Chet

    “Chapters
    4-6 show that phospholipids that occur naturally in biological membranes are
    piezoelectric and the piezoelectricity is caused by molecular chirality. This could have major biological implications” is hot off the presses here.

    Ok, but look – by the time you’re talking about the piezoelectricity of membranes, you’re dealing with charge fields so weak and so small as to be completely drowned out by the electrical field of, say, being within a mile of mains electricity. If you’re ascribing therapeutic value to these fields then, by comparison, a 9-volt battery held against the skin should cure cancer (or, alternatively, cause it.)

    And the idea that the therapeutic value of these fields could be discovered thousands of years before the invention of the microscope, the identification of the cell, or even the Leyden jar, beggars belief! Piezoelectricity isn’t scientific support for magic, Scot, but that’s exactly how you’re using it. I mean you might just as well attempt to explain the invented efficacy of acupuncture with quantum mechanics. I mean your whole argument is “look at this phenomenon in the body! It’s much weirder than anyone expected and we don’t understand it, really… therefore I conclude that acupuncture works because of it. And you can’t contradict me because, hey, you don’t understand it either.”

    In short, acupuncture is the single treatment modality currently outside of what is known as “medicine” that has a very high approval rating among medical doctors.

    Creationism also has a high approval rating among medical doctors. Medical doctors, generally, aren’t especially scientific. About as scientific as engineers, usually.

    A couple of examples would include increases in cardiac volume, neurological effects that can be viewed under fMRI, and many others.

    I would certainly expect the penetration of the body with needles to have a neurological effect!

    And in my practice I do actually observe that there is a movement, through the body, of “something” that circulates constantly and everywhere, but is separate to the circulation of the blood.

    No, you don’t actually observe the flow of anything. What you actually observe is pain, redness, and swelling, which you then explain with recourse to supernatural “circulations” of energy.

  • Scotlyn

    And the idea that the therapeutic value of these fields could be discovered thousands of years before the invention of the microscope, the identification of the cell, or even the Leyden jar, beggars belief!

    I do not hold to the strange belief that all discoveries of things useful to humans were discovered only in the last 100 years. Although, I do agree, the last 100 years have done a lot to explain why most such things are useful, and to separate the truly useful from the less useful, the utility of a great number of substances, procedures, etc have been discovered in many times and places by intellectually curious and highly motivated people, probably starting with fire, about 2 million years ago, if Greg Laden is right. The context of the development of acupuncture was a period of about 100 years of very active scholarship in China, of a concerted intellectual search for more natural explanations of disease than the current “insufficiently venerated and unhappy ancestors” superstitious explanations, and moreover, based on detailed clinical observations of real people and real courses of disease. (What New Age hippies have done with these ideas is a completely different story!) Its roots included internal discoveries of observable currents within the body that people could become aware of by following certain energetic and sexual practices that come under the heading of self-cultivation. These are easily replicable and hardly magical.

    Piezoelectricity isn’t scientific support for magic, Scot, but that’s exactly how you’re using it. I mean you might just as well attempt to explain the invented efficacy of acupuncture with quantum mechanics. I mean your whole argument is “look at this phenomenon in the body! It’s much weirder than anyone expected and we don’t understand it, really… therefore I conclude that acupuncture works because of it. And you can’t contradict me because, hey, you don’t understand it either.”

    I do really know and understand how it seems to you, and also that nothing I could say will convince you (and ps, only my grandmother ever got away with calling me Scot). I am not a researcher or a conductor of studies. I have to rely on other people to take enough interest and spend enough money to do that. But of course you realise that the order of your statement is backwards. For me the observing the workings of acupuncture comes first – and observing what works in the clinic and what doesn’t. The applied experience of something that works, coupled with the fact that I don’t believe in magic, means that I do expect these applications will find a physical explanation at some point. It’s like seeing the sunset and not understanding it, but knowing there is an explanation somewhere.

    No, you don’t actually observe the flow of anything. What you actually observe is pain, redness, and swelling, which you then explain with recourse to supernatural “circulations” of energy.

    Yes, you are right. What I observe are physical symptoms, but they map along certain pathways, as I said, in an “upstream” or “downstream” manner – like inferring a flow of water from a dry riverbed.

    I do realise that this level of evidence counts for little in this type of argument, as I only have my word for it, and that of my patients – every single bit of it “anecdotal”. Therefore I have not tried to rely on it here. However, I do wish to convey that it is in order to try to make sense of my real-world experiences and observations that I turn to familiarising myself with the physiological research that might throw light on the connections between the part of the body I am interacting with, and the parts of the body that are influenced thereby.

    I should hasten to add that the actual explanation for acupuncture matters very little to the people who seek me out (I don’t advertise except in the Golden Pages). I have never once had anyone ask to have their “qi” balanced or adjusted. I have never been asked to remove a blockage in a channel. People certainly do not come here in search of magic or spiritual enlightenment or even of “ancient wisdom.” People come looking for respite, mainly from pain, occasionally from other intractable and annoying symptoms. Simple respite. And in a large majority of cases, that is what they get here. And that is all that matters to them.

    I would hasten to add, that people also do not come to me to lay their minds at rest about their health. If they are afraid that a symptom might mean they have an underlying disease, they go to their GP. In the rare case that anyone should ask me for a medical diagnosis of a symptom, I decline, and refer them back to their GP. But in a small way, the respite I can give can mean a huge increase in quality of life.

    And every person who comes into my clinic receives this assurance – “you are entitled to a full refund if you are unhappy with any aspect of your treatment.” In that guarantee I include “any aspect of your treatment” to mean “if it doesn’t work.” And in those cases where acupuncture is not working for someone, I always point to the sign and offer the refund. People generally refuse – I suspect, because they insist on allocating the responsibility for making the attempt to themselves.

    Whatever acupuncture is, it’s not magic, it is physiological, but you’re right, I can’t explain it (although it’s fun trying). But I do think that someone will, probably sooner rather than later. In the meantime, I do what I do conscientiously, I await physical confirmation, and I do not rip people off.

  • Chet

    I do not hold to the strange belief that all discoveries of things useful to humans were discovered only in the last 100 years.

    You’re talking about physiological effects that even now we don’t have the hardware to fully detect. It beggars belief to suggest that ancient peoples could be capable of detection.

    You’re suggesting that cavemen discovered the top quark. It’s an absurdity. You must realize that.

    I do really know and understand how it seems to you, and also that nothing I could say will convince you

    Untrue. Evidence would convince me. I’m a skeptic, not a disbeliever. Consider me a resident of Missouri – the Show Me State. Show me the “observable” energy fields in the body.

    What I observe are physical symptoms, but they map along certain pathways

    What pathways? How do you observe these “pathways”?

    I should hasten to add that the actual explanation for acupuncture matters very little to the people who seek me out

    Well of course not. That’s why it’s so important for skeptics to expose peddlers of pseudoscience like yourself.

    In the meantime, I do what I do conscientiously, I await physical confirmation, and I do not rip people off.

    Unfortunately, and perhaps unknowingly, you do. I’m sorry but that’s the plain truth. There’s no legitimate support for what you do, it never holds up in placebo studies, and the relief your patients may find comes from their own minds, not from your treatment. I accept that you’ve convinced even yourself that it works, which is probably in part why it seems to work so well for your patients, too.

    But you’re ripping them off.