Acupuncture Critic Misses Big Points

Recently the Guardian ran an article by David Colquhoun, a professor of pharmacology at University College London, complaining about peer review. His complaints were innocuous; what was interesting was his example. How bad is peer review? he said. Look what gets published! He pointed to a study of the efficacy of acupuncture and included graphs of the results. “It’s obvious at a glance that acupuncture has at best a tiny and erratic effect on any of the outcomes that were measured,” he wrote.

Except it wasn’t. There were four graphs. Each had two lines — one labelled “acupuncture,” the other labelled “control”. You might think to assess the effect of acupuncture you compare the two lines. That wasn’t true. The labels were misleading. The “acupuncture” group got acupuncture early in the experiment; the “control” group got acupuncture late in the experiment. Better names would have been early treatment and late treatment. You could not allow for this “at a glance”. It was too complicated. With this design, if acupuncture were effective the difference between the two lines should be “erratic”.

The paper’s data analysis is poor. To judge the efficacy of acupuncture, their main comparison used only the data from the first 26 weeks. They could have used data from all 52 weeks. That is, they ignored half of their data when trying to answer their main question. Colquhoun could have criticized that, but he didn’t.

Colquhoun’s criticism was so harsh and shallow, apparently he is biased against acupuncture. But there are two big things few pharmacology professors appear to know. One is how to stimulate the immune system. This should be central in pharmacology, but it isn’t. Half of why I think fermented foods are so important is that I think they stimulate the immune system. (The other half is they improve digestion.) There are plenty of less common ways to do this. The phenomenon of hormesis suggests that small doses of all sorts of poisons, including radiation, stimulate repair systems. The evidence behind the hygiene hypothesis suggests that dirt improves the immune systems of children. Bee stings have been used to treat arthritis. And so on. In this context, sticking needles into someone, which puts a small amount of bacteria into their blood, is not absurd. Acupuncture also allowed patients to share their symptoms, the value of which Jon Cousins has emphasized.

The other big thing Colquhoun doesn’t seem to know is the absurdity of the chemical imbalance theory of depression. Speaking of ridiculous, that’s ridiculous. Which plays a larger role in modern medicine — antidepressants or acupuncture? If you want criticize peer review, criticize the chemical imbalance theory. It is as if peer reviewers have been saying, yes, the earth really is flat for fifty years. Perhaps this is ending. During a talk that Robert Whitaker gave at the Massachusetts General Hospital in January, he was told by doctors there that the chemical-imbalance theory was an “outdated model”.

Thanks to Dave Lull and Gary Wolf.

 

6 Replies to “Acupuncture Critic Misses Big Points”

  1. > In this context, sticking needles into someone, which puts a small amount of bacteria into their blood, is not absurd.

    In the vast acupuncture literature, no particular importance has been noted about breaking the skin barrier… eg. http://www.sciencedaily.com/releases/2008/12/081201082353.htm

    > 109 received traditional acupuncture, with needles penetrating the skin in particular points. According to ancient Chinese tradition, the needle is twisted until a certain ‘needle sensation’ arises. The other 106 patients received a simulated acupuncture instead, with a telescopic, blunt placebo needle that merely touches the skin. The acupuncture was performed by physiotherapists two or three times a week throughout the five-week radiation period.
    >
    > Afterwards 95 percent of the patients in both groups felt that the acupuncture treatment had helped relieve nausea, and 67 percent had experienced other positive effects such as improved sleep, brighter mood, and less pain.

  2. Another anti-bacteria point that occurred to me this morning.

    The usual way acupuncture trials are blinded are by sticking in needles in places which *aren’t* the special chi meridians or whatever hogwash that particular acupuncture claims.
    Presumably both the meridians and random points near meridians are equally unclean, and so studies should never show a difference beyond random noise and bias if the bacteria point were true (both ‘control’ and experimental groups being equally contaminated); but acupuncture is still a live issue, so…

  3. Well, you may have written a book about diet, but I have written a textbook on statistics. If you want to get mathematical I’ll take happy to take you on,

    You really shouldn’t invent things. I have never from its start thought much of the “serotonin hypothesis”. As it happens I’m talking tomorrow to clinicians about, among other things, that downfall of SSRIs, once the whole evidence emerged (and incidentally, the downfall with them of St John’s Wort, which every herbalist boasted is as good as SSRIs.

    Talking of made up theories, the corniest of all has to be “stimulating the immune system”. There is, and never has been, any evidence that it happens -it is the eternal mantra of every quack who is trying to sell you their own brand of implausible therapy.

    Incidentally, it is considered polite to spell authors’ names correctly.

    Gamma minus

    1. Prof. Colquhoun, I have fixed the spelling of your name, thanks for the correction.

      As for the rest of your comment, I am glad you never took the “serotonin hypothesis” seriously. Because antidepressants are far more important than acupuncture, that theory would have been a far more interesting target of criticism than an acupuncture experiment. You say that stimulating the immune system is the “eternal mantra of every quack”. And I say that few pharmacology professors know how to stimulate the immune system. We seem to agree here. If you would like evidence that the immune system can be stimulated, you should study the many connections between better sleep and better health. I am sure that sleep stimulates the immune system. If you would like to see evidence of immune stimulation by something like drugs, check out studies of the effects of probiotics on health. Finally, as for statistics, I believe that your criticism of the acupuncture graphs was misleading and you failed to point out a really big blunder in the acupuncture paper — ignoring half of their data when answering their biggest question. But perhaps we agree here too. You say peer reviewers make big mistakes. I say you — who surely review many papers — made big mistakes. You see the similarity of our positions, I hope. It seemed to me that the pot was calling the kettle black.

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