Placebo - pregnancy pain cure

OK, I changed the headline. The actual headline on the BBC article was “Acupuncture – pregnancy pain cure”. But considering there were no controls for placebo, I think my headline is more accurate. (Full study .pdf)

First, a reminder of what acupuncture is, from Bob Park:

Here's the picture: a few thousand years before it was known that blood circulates or germs cause disease, doctors who had never dissected a frog, claimed that yin and yang could be balanced by inserting needles into the right points, among the hundreds of points strung along 12 meridians. They called it "acupuncture," from the Latin acus, needle and punctus, prick. Which is odd, because they were Chinese. But if they figured out acupuncture, they must have been smart enough to learn Latin. Scientists today can't even find the meridians.

Nor, might I add, have they ever been able to detect the “qi” (pronounced “chi”), that supposedly runs through these “meridians. (As an aside, why is it pronounced “chi” but written as “qi”? Surely the Chinese wrote in Chinese characters so why can’t we just write “chi”? Oh never mind.)

NCCAM states that the body has more than 2,000 acupuncture points; the ones you use depend on the illness you are trying to fix. How did the ancient Chinese figure all this out? They didn’t, they made it up, just like medieval European doctors with their four “humors”. We now know that “humors” don’t exist; the only mystery is why people still believe in “qi”. The trouble for acupuncture is that studies show it doesn’t matter where you stick the needles. What does matter is that the victim patient believes you are sticking them in the right place. In other words, if acupuncture works at all, it is not by releasing blocked “qi” at the correct specific points (out of 2,000), on a “meridian”. Most studies conclude acupuncture doesn’t work or if it does it is a placebo. So you’d think a new study would control for placebo. Think again.

This is a description of the study, from the BBC article:

The team studied the effect of three six-week treatment programmes on 386 pregnant women suffering from pelvic girdle pain, which it is thought is caused by hormones affecting ligaments and muscles.

One group were given a standard home exercise routine, a second received the exercise routine and acupuncture, while the third had a specialised exercise regime aimed at improving mobility and strength.

No attempt was made at sham acupuncture to control for placebo. Why not? It’s not as if this is a new idea, many studies have been done with this procedure. It’s inexcusable. As is the additional comment:

Pregnant women should be avoiding drugs so acupuncture, which releases the bodies natural painkillers, should be of benefit.

(My bold.)

I presume by this he meant the idea that acupuncture might work by releasing endorphins. Well firstly, that’s not acupuncture. (Remember, acupuncture is the magic thingy with the “qi” and the “meridians”.) Secondly, I’m not aware of any studies that have actually shown that acupuncture, if it works, does so by releasing endorphins - it’s just an assumption. I’d be prepared to accept “releasing endorphins” as a possibility. But it’s a bit much to state it as a fact. (And there are easier and less invasive ways to release endorphins than by sticking needles in people.)

In truth, acupuncture only works for subjective things such as pain and nausea. And even then, if it works, it is probably due to the usual reasons people think alternative therapies work. Namely, placebo, misdirection (the needle makes you forget the other pain), the cyclical nature of the illness (it goes away by itself), incorrect diagnosis to start with, temporary mood improvements due to the personal nature of the treatment, psychological investment of the patient in the success of the therapy and other medicines the patient is taking. And for acupuncture, possibly endorphins.

Mind you, “placebo, misdirection, cyclical nature of the illness, incorrect diagnosis to start with, temporary mood improvements due to the nature of the treatment, psychological investment of the patient in the therapy, other medicines the patient is taking and possibly endorphins - pregnancy pain cure” would be too long for a headline. I’ll stick with my original.

Comments

[Joseph Thompson]

Great blog. Found out about it from reading James Randi's piece on that Ramtha infomercial . . .

"(As an aside, why is it pronounced “chi” but written as “qi”? Surely the Chinese wrote in Chinese characters so why can’t we just write “chi”? Oh never mind.)"

Because the Mandarin language was simplified under Communist rule. Both are correct, although "qi" is the official Pinyin transliteration of the syllable and "chi" may be confused with the Greek letter.

That's why most recent woo-woo works spell it "qi".