You got that right. The recipient must believe, too, to make it work. Which is why veterinarian acupuncture is such a failure. How do you get a dog to believe it works?
several years ago, i was having problems with my spine … got so bad, couldn’t move when lying in bed at night. eventually, i saw an acupuncturist … once the first 50-min session completed, i was able to turn my head like i used to … and there were other maladies the treatment also helped with. after a few more sessions, i decided no more were necessary. six months later … feet were swelling up (substantially) … doctor at an emergency-clinic took one look and told me i had acquired dvt*(deep vein thrombosis)*. looking online, i noted several instances of people becoming plagued with dvt after being treated by acupuncturist … but nothing definitive. either way … my feet are still pretty much messed up.
so … the jury is still out on this … perhaps i had a pre-existing condition which became worse once i was treated by the accu-specialist.
This is a major criterion for me.
The treatment should be effective whether I believe in it or not.
You can be skeptical of antibiotics all you want, but if the bug causing your infection is susceptible, the infection is liable to clear up anyway.
But maybe antibiotic resistance is from the bacteria that don’t believe in antibiotics?
I believe I read in Ben Goldacre’s excellent book, Bad Science, that a large study comparing several medical and “alternative” treatments for lower back pain found that although “real” acupuncture did no better than sham acupuncture, both were more effective than any of the other treatments in the study.
I hesitate to suggest what the medical and ethical implications are if the best treatment for something turns out to be an elaborate placebo!
It’s been a while since I read the book, and I don’t have my copy any more. Maybe someone else could check and find the actual study, and whether it’s been replicated?
It’s difficult to evaluate effectiveness of therapies for conditions such as lower back pain (and for migraines for that matter*), given that these conditions have a large number of causes/triggers, wax and wane over time and have historically been relieved (generally in the short term) by many different interventions and prevention strategies.
Up-to-date reviews suggest that such things as exercise and stress reduction work about as well as drug therapy (or, for that matter, spinal manipulation or acupuncture) for chronic lower back pain.
Doing something (and having a sympathetic practitioner/coach) most likely will show benefits for certain conditions, at least for awhile.
*I had migraines in the past (they went away on their own) and periodically have brief flares of lower back pain. I could point to various things I did as proof that they alleviated these problems, but I’d be kidding myself.
Another major criterion (for me) is there has to be a mechanism of action.
Acupuncture works? Tell me why.
ETA: and if the supposed mechanism is silly, I reserve the right to laugh.
I’m sure there are. If you were a true believe in acupuncture you’d rationalize a reason to believe that.
I don’t think the concept of acupuncture is total nonsense. Great consideration is given to the idea that scratching and picking at a wart will trigger an immune system response that will kill the virus that causes the wart. Some similar kind of thing could be happening with acupuncture. The practice has been around for a very long time, some amount of refining of the process could identify certain locations on the body where poking a needle in will have some likelihood of good results. But without scientific study it’s probably hit or miss, and the placebo effect being a large factor as well.
I’ve seen endorphin release mentioned. Also possibly a counter-irritant effect, but I don’t know if the needles actually hurt much.
Veterinarians in the olden days would “fire a joint” literally burning the tissue around a sore joint. The mechanism of action claimed was the old “counter irritant effect”. Likewise, humans would have the skin of their chest blistered for pneumonia, same supposed mechanism of action.
…needleless to say?
Fine, let’s rule out “chance” as an explanation. That still leaves an obvious explanation that the practitioners where giving subconscious signals to the patients, subtly hinting to them that the treatment was just a placebo. That’s why good science tries to use double blind experiments. It’s hard to imagine how the experiment described here could have been double blind. Certainly, it could be blind from the patient’s point of view, just don’t tell them whether they are in group A or group B. But the experimenters certainly knew. Group A got help from trained accupuncturists who (one would assume) believed that their therapy was real and they were genuinely TRYING to succeed. Group B got the placebo effect from either trained accupuncturists who were intentionally doing it wrong and KNEW they were doing it wrong, or from untrained non-accupuncturists who KNEW they were not trained, hence the therapists in group B WEREN’T TRYING to make the patient feel better, and the patients might have picked up on that.
All the experiment shows is that placebos work 18% better if you believe your own bullshit. The mechanism is easy to figure out. There is great power in having someone express a sincere interest in making you feel better, compared to someone who is being insincere and doesn’t really care at all. Patients who get placebos from sincere wackos will feel better than patients who get placebos from an unbiased scientist who is merely pretending to be a sincere wacko.
This is all purely speculative. Right now the best science that’s available says that acupuncture likely reduces the frequency of migraine headaches in migraine sufferers.
You misunderstand the nature of the placebo effect as well. It’s not about some magical healing power of the mind, it’s really just a catch-all term for any observed improvement that wasn’t due to the intervention, such as regression to the mean, the body healing itself, gradual adaptation to the effects of the condition, other common interventions, etc.
Sometimes it’s a question of who is allowed and why …
In many jurisdictions, an MD doctor can be licensed in acupuncture after attending a weekend seminar on the subject. How good do you think that care is going to be based on that level of skill?
I’ve known practitioners who were not medical doctors. They studied in China for years, often also studying the use of Chinese herbs as well. Some of them had degrees … that were not accepted in the United States. Since they were not MDs they could not be licensed and could not practice openly.
Had acupuncture from both kinds of practitioners. With the MD guys, I’m pretty much 0-for-everybody. They did shoddy work and it didn’t help.
With the Chinese trained acupuncturists I’ve always been helped. Between the treatments themselves (acupuncture, therapeutic massage, and herbs) I’ve had a whole lot of betterment in my condition. I wish I could find another of these practitioners, I’d gladly go again.
Just reporting on what I’ve found. I have met at least one doctor who took the weekend seminar but knew he didn’t know anything and was working to learn more … I hope he persisted and uses those skills today.
Here’s what wikipedia has to say, under “what Placebo really is”:* In 1985, Irving Kirsch hypothesized that placebo effects are produced by the self-fulfilling effects of response expectancies, in which the belief that one will feel different leads a person to actually feel different.[39] According to this theory, the belief that one has received an active treatment can produce the subjective changes thought to be produced by the real treatment. Placebos can act similarly through classical conditioning, wherein a placebo and an actual stimulus are used simultaneously until the placebo is associated with the effect from the actual stimulus.[40] Both conditioning and expectations play a role in placebo effect,[41] and make different kinds of contribution. Conditioning has a longer-lasting effect,[42] and can affect earlier stages of information processing.[43] Those that think that a treatment will work display a stronger placebo effect than those that do not, as evidenced by a study of acupuncture.[44][45]*
As for the need for double-blind studies to avoid accidentally giving clues to the test subjects, I highly recommend reading about The Clever Hans Effect. This is not mere speculation. It’s been shown to exist. That’s why double blind studies are better than single blind studies.
I can show you an arm, a leg, an eye, a heart, and a vein, and I’m not even a doctor. Can you show me a meridian?
It’s also possible that the experience Chinese trained acupuncturists were better at producing the placebo effect. The placebo effect is real, and mysterious, no one knows how it works exactly, but there’s ample evidence that the mind is a factor in healing.
Speaking of published research and systematic reviews involving acupuncture: there’s reason to be cautious about their findings.
*"Unfortunately, poorly done systematic reviews can create an strong but inaccurate impression that there is high-level, high-quality evidence in favor of a hypothesis when there really isn’t. Reviews of acupuncture research illustrate this quite well…
While there is no question that some great scientific research is done in China, there is evidence for a systematic problem with the conduct and publication of alternative medicine studies there. Studies reported as randomized are most often not actually properly randomized. And one review in 1998 found that no negative study of acupuncture had ever been published in China* (bolding added). This strongly suggests that the acupuncture literature coming from China is unreliable due to poor methodological quality and a high risk of publication bias."
While I hesitate to cast doubt on TubaDiva’s testimonial (well, I don’t hesitate all that much), I wonder if she’d have noticed such a dramatic difference in treatment efficacy if she’d been unaware of the country of origin/site of training of her acupuncturists.*
*recall that there’s published research showing that sham acupuncture (inserting needles in the "wrong’ locations, or using a sheath to simulate needle insertion) works as well as “real” acupuncture.
**I may have mentioned this before in another thread, but years ago I had a couple of sessions of acupuncture for a certain health problem. On the one hand it didn’t have any perceptible effect; on the other hand I respected the acupuncturist telling me that based on the lack of results I should probably try some other therapeutic modality. So I don’t have a built-in contempt/loathing for acupuncture, any more than my opinion of any alt med practice that is based on a nonsensical framework and claims widespread positive results based heavily on testimonials and other highly dubious evidence.
It says much less than that, really. It shows that patients are 18% more likely to report a reduction in symptoms if the practitioners believe their own bullshit. Since the symptoms of migraine are completely subjective, the difference could be entirely a result of patients reporting better results to the more enthusiastic practitioners.
How can you credit acupuncture with whatever benefits you may have received when you received three different forms of treatment at the same time?