Believe it or not, there was a time when I didn't consider acupuncture to be a form of woo.
I know, I know, it's hard to believe, given the sorts of posts I've done recently on acupuncture, but it's true. Certainly, I didn't believe the whole rigamarole about needles somehow "restoring the flow of qi" or anything like that, but I did wonder if maybe there was some physiologic mechanism at work behind acupuncture that produced real benefits in terms of pain relief above that of placebo. Sure, I may have dismissed homeopathy as the pure magical thinking that it was, but acupuncture I wasn't so sure about.
Obviously, that's changed.
The reason my opinion has changed and now I place acupuncture firmly in the "woo" category is that I've actually been reading the scientific literature on acupuncture over the last year or so. From such a reading of the literature, it has become very obvious to me that (1) the vast majority of research into acupuncture is shoddy in the extreme, with methodological problems that greatly increase the probability of false positive trials; (2) many investigators conflate electroacupuncture which is in reality nothing more than the "conventional" modality of transcutaneous electric nerve stimulation rebranded, with acupuncture itself (unless the ancient Chinese knew how to make electrical nerve stimulation devices, which I highly doubt); and (3) when trials are done with true sham acupuncture there is almost invariably no difference detected between the true acupuncture and the control group.
This time around, I've come across yet another acupuncture study that serves to demonstrate that acupuncture is nothing more than an elaborate placebo. The paper, published in the most recent issue of the Clinical Journal of Pain joins a long line of papers that show that, when the study is well-designed and includes true sham acupuncture, the results virtually invariably show acupuncture to be useless as a therapy. This particular study came out of a collaboration between Harvard Medical School, the University of Michigan School of Public health, and the Harvard School of Public Health and examined the effect of acupuncture on persistent arm pain due to repetitive stress injuires (RSIs).
The study design was fairly simple. Through June 2001 and April 2003, the investigators recruited men and women from the greater Boston and Cambridge areas through advertisements and referrals from health care professionals. Eligibility was determined through screening interviews by research assistants involved in the study. The only twist in this study is that apparently there were two studies (acupuncture versus sham acupuncture and acupuncture against medication), and participants were randomized to one of them and further randomized to either the sham acupuncture group or the "true" acupuncture group. Of course, one of the silly things about this or any acupuncture study is how the "true" acupuncture treatment is identified:
Acupuncture treatments focus on relaxing the muscles and opening channels to the circulation of what acupuncturists call ''qi.'' Point selection in our study was based on the location of the pain, limitations to the range of arm motion, and local sensitivity to palpation. Local channel points proximal to the area of pain were combined with distal points that control the area of pain. Nonmeridian local ''trigger'' points (''ah shi'' points) were included. To incorporate the acupuncture theory of ''opening the gates'' in pain conditions, all participants received needling on Liver 3 (a point near the big toe) on the contralateral side of the affected arm, which was paired with Large Intestine 4, a point on the hand of the affected arm.14 If both arms were affected, the latter point was needled bilaterally.
A consensus team of senior acupuncturists selected 20 allowable acupuncture points based on the acupuncture literature. We used a ''manualized'' approach27 that allowed some flexibility to vary the location of points according to the specific location and nature of the pain, while providing standardization of treatment. Besides the required points, practitioners could select between 5 and 8 additional points at each session and could include local area points traditionally used to affect specific regions (ie, LI 5, P5, P6, P7, and TW5) and local and distal sensitive ''ah shi'' points.
Clear enough to you? Personally, it's clear as mud to me. However, since "certified" acupuncturists picked the needle points, I can only assume that they picked points that they thought would yield the best chance of a therapeutic result. The "sham" acupuncture was performed at the very same acupuncture points but using sham needles with blunt ends that retract back into the needle hub after hitting the skin. They have been validated before and look and feel like "real" acupuncture needles. The only weakness in this study was that, although patients and the research assistants who recorded the pain levels and measured range of motion were blinded to the experimental group, the actual acupuncturists were not. However, blinding was assessed by asking patients whether they thought they were in the placebo or true acupuncture group, and similar percentages thought that they were getting true acupuncture. Be that as it may, the acupuncture regimen used included eight treatments administered over four weeks.
So what were the results?
Here's where things get amusing. Both treatment groups, "true" and sham acupuncture, experienced decreases in the intensity of arm pain, arm symptoms, and noted improvement in arm function. However, patients in the sham acupuncture group improved more than patients in the "true" acupuncture group in the intensity of arm pain and just as much in measures of arm function and grip strength. The difference between the two groups was not sustained at a followup visit one month after the treatment ended, although the improvement in both groups remained detectable compared to baseline. Indeed, arm pain and arm symptoms scores declined faster in the sham compared with the "true" acupuncture group.
In this study, which was the largest, best-designed trial thus far for acupuncture for arm pain due to RSI, sham acupuncture was better than "real" acupuncture!
Not that any of this keeps the authors from trying to explain how sham woo is better than the woo itself:
Reasons for the superiority of the sham acupuncture device during treatment are not clear. One possibility is that treatment effects were blunted in the true acupuncture group because of the higher rates of side effects, and especially mild pain during treatment. We speculate that this discomfort may have been due to some of the needle placements in the arm, in close proximity to the painful areas. Another possibility might be that the sham device may have conferred genuine treatment effects, because it was applied to real acupuncture points (an ''acupressure'' effect). This seems less likely given the results of another RCT testing acupuncture in the treatment of fibromyalgia that found no significant differences between true acupuncture, noninsertive simulated acupuncture at true acupuncture points, and true acupuncture needling at nonacupoints.
Yeah, it's a real bitch when your study shows about as conclusively as possible that acupuncture is nothing more than a placebo. Not that our intrepid investigators don't try very hard to find something--anything-- to salvage this study:
One limitation of our study may have been that 8 treatments over 4 weeks were insufficient to achieve maximum benefits from true acupuncture, because other studies have demonstrated the need for longer treatment periods to demonstrate statistical differences between the treatment and control groups. For example, in patients treated with acupuncture for osteoarthritis of the knee, Berman et al44 found no significant effects on pain scores until the 14th week of treatment, when pain had decreased by 40% in the true acupuncture group compared with 30% in the sham control. Even then, it is not clear whether the 10% difference would be clinically important.
Actually, it is, and it wouldn't be.
The bottom line is that this study is yet another in an increasingly long line of studies that demonstrate that acupuncture is nothing more than an elaborate and fancy placebo. Personally, if we're going to start using placebos to treat arm pain, I'd hope that we could find one that doesn't necessarily involve sticking needles into one's body to achieve its effects. Better yet would be to find and use therapies that actually produced a result greater than that of a placebo. Unfortunately, acupuncture isn't one of those therapies.
Also unfortunately this study is yet another in a long line of negative studies funded by the National Center for Complementary and Alternative Medicine. Yes, indeed, it's your tax dollars at work again.
REFERENCE:
Goldman, R.H., Stason, W.B., Park, S.K., Kim, R., Schnyer, R.N., Davis, R.B., Legedza, A.T., Kaptchuk, T.J. (2008). Acupuncture for Treatment of Persistent Arm Pain Due to Repetitive Use: A Randomized Controlled Clinical Trial. Clin J. Pain, 24(3), 211-218.
"unless the ancient Chinese knew how to make electrical nerve stimulation devices, which I highly doubt"
I remember reading about the ancient Egyptians making very simple batteries, and that some people have speculated it might have been used for that sort of thing. (I also vaguely remember a Mythbusters about that, now that I think of it, but I can't remember if they were able to demonstrate any usefulness with it.)
I've had several friends and family members get into acupressure in recent years, for back pain and the like..anyone know if that's any better a form of therapy?
I expect you will continue to see public money spent on acupuncture studies. I hear the "it worked for me " justification over and over.
Does anybody have any thoughts On "Intra muscular stimulation" which is sticking acupuncture needles into "shortened" or stiff muscles to relieve pain?
It seems like woo to me, but I'm not really sure.
Even if something like this turned out to work, is there any reason to think it would be any better than medications? I mean, treatments twice a week at $40-50 a session will run into $400 a month. And if it takes three months for the results to be appreciably better than placebo ... well, $400 a month buys a lot of sugar pills.
Maybe it just proves the efficacy of 'Homeopathic acupuncture'.
Very very interesting.
I'd be interested in seeing a study that uses non-acupuncture points with the "sham" needles, just for even more conclusive evidence. There's still that variable of using the "real" acupuncture trigger points.
Perhaps it's more than just a "placebo" effect, too. Perhaps acupuncture is seen as a calming and relaxing event?
why didn't they do additional sham acupuncture by using wrong sites? that would have really nailed the placebo effect. It would seem that this experiment would be open to an interpretation that acupressure is better (or as good as) acupuncture.
"Yes, indeed, it's your tax dollars at work again."
I would be pleased if this study and others eventually caused government and insurers to stop paying for this bullshit procedure. That indeed would be tax money well-spent.
I'm just fine with having my tax dollars go to debunk woo, really.
Not that the problem is negative studies in themselves; it's the refusal of NCCAM and CAM practitioners to accept those results and act on them accordingly by abandoning treatments that are found to be medically ineffective. Otherwise the whole exercise is nothing more than a glorified [and ethically negligent] fishing expedition.
I wonder how much money I could make by opening up a "sham acupuncture" clinic.
This study does not show that acupuncture is a shame, only that the placebo effects of sham acupuncture are more effective. It is important to avoid drawing false conclusions from this study.
While I place very little interest on acupuncture, and care little for it, details of the scientific method are very significant for me.
It is important to consider the two treatments, sham acupuncture and real acupuncture, as well as the symptoms from which they are derived. The placebo effects of sham acupuncture are due to the very impressive ability of the brain to manipulate it's own experience of pain, as well as modulate the body's response to stimuli. It is possible that the effects of true acupuncture are real, but more subtle and less effective than the effects of the placebo.
It could even be that given certain symptoms, true acupuncture could prove to be more effective than the placebo effect.
It is my opinion that the placebo effect is treated as a sort of epiphenomena, with no basis other than to detect and prove or disprove other treatments. In truth, it actually implies that the brain and our thoughts have an effect on our body's own health.
/opinion
Not that the problem is negative studies in themselves;
One would think that the government is actually providing a valuable public service here by conducting studies debunking popular but ineffective treatments. Of course, as you note those studies don't really count for much unless they're in some way acted on by someone...
I remember reading about the ancient Egyptians making very simple batteries, and that some people have speculated it might have been used for that sort of thing. (I also vaguely remember a Mythbusters about that, now that I think of it, but I can't remember if they were able to demonstrate any usefulness with it.)
And it was then that Nyarlathotep came out of Egypt. Who he was, none could tell, but he was of the old native blood and looked like a Pharaoh. The fellahin knelt when they saw him, yet could not say why. He said he had risen up out of the blackness of twenty-seven centuries, and that he had heard messages from places not on this planet. Into the lands of civilisation came Nyarlathotep, swarthy, slender, and sinister, always buying strange instruments of glass and metal and combining them into instruments yet stranger. He spoke much of the sciences of electricity and psychology and gave exhibitions of power which sent his spectators away speechless, yet which swelled his fame to exceeding magnitude. Men advised one another to see Nyarlathotep, and shuddered. And where Nyarlathotep went, rest vanished, for the small hours were rent with the screams of nightmare. Never before had the screams of nightmare been such a public problem; now the wise men almost wished they could forbid sleep in the small hours, that the shrieks of cities might less horribly disturb the pale, pitying moon...
to quote our Vice Prez..so? It's not going to change the minds of the CAM types. They're still going to bilk the US government of millions of dollars in their Alternative Medicine program and force this crap on hospitals and medical schools.
Coin: I came up with the "Sham Acupuncture Clinic" idea first!!
http://ichthyologistbright.blogspot.com/2007/12/doggie-acupuncture_28.h…
Darn it, why do ALL of my good ideas always seem to get stolen by people with time machines?!
Sean Nicolle:
IANAS, but you seem to overlook an obvious point: the placebo effect applies in the real procedure too.
The baseline against which efficacy of the 'real treatment' is measured isn't zero - it's the level set by the control. Thus [assuming all other factors are controlled for, which they'd better be or the 'trial' ain't worth squat], no statistically significant effect above that seen in the sham sample means that it's bobbins.
Coin:
Call it "shaman acupuncture" and you'll be minting it. Two woos for the price of... um, two woos.
Never mess with a Time Lord.
I'm ashamed to admit that I tried kitty accupuncture years ago. I went to one session wherein the accupuncturist told me that my cat would stop squirming after a few sessions because he would realize it was working for him and making him feel better. Because, you know, creatures who chase their tails in the bathtub are all about understanding cause and effect.
In truth, it actually implies that the brain and our thoughts have an effect on our body's own health.
I think the most that can be said for placebo -- and this is not insignificant -- is that it can alter perception. If it can diminish pain, great. But I don't think any evidence points to an ability to actual treat conditions.
Also, it's really expensive; you also need to consider the alternatives. $50 buys a lot of wine.
Liesl - ZOMG! Kitty accupuncture! I'm sure your cat has forgiven you by now, even if she was thinking, "WTF? Why are you giving me this crap placebo treatment??!"
inkadu: I hang my head in shame. Although, in my defense my at the time boyfriend, a surgical oncologist, told me that accupuncture had been accepted by some medical association and I believed him. Rat fink! Laughing Gravy (kitty) forgave me but, but barely. The funniest story I have about homeopathy centers around a homeopath I allowed my mother to drag me to before we knew I had autoimmune diseases. But that's a story for another time.
There's probably about a billion Chinese who would likely disagree with this study. I think the truth lies somewhere in between. There are definitely sham practitioners in all the fields of medicine including the empirical, allopathic and western medicine varieties. And yes, the placebo effect works for acupuncture the same as it works for prescription medicines, it is a strong factor not to be discounted in any of the above mentioned fields.
From the study...
I think here lies a problem in the methodology of such a study. True Chinese practitioners do not use such a cookbook of points. They do what they do by doing examination of the patient and using for example... pulse point diagnosis. I realize, many would say what? And is this scientific... absolutely no it is not scientific, it is totally empirical. But, herein lies one of the fundamental differences between Chinese and western medicines. This is also the very reason western physicians think this is a sham and why Chinese practitioners believe western practitioners merely treat the symptoms of problems. I am not saying the study did not have good intentions, only that I don't believe it was likely as truly scientific as one would have hoped.
@Sean Nicolle "It is possible that the effects of true acupuncture are real, but more subtle and less effective than the effects of the placebo."
Less effective than a placebo? Sounds like a great treatment to me! Sign me up now!
With all due respect, speaking as a person who is a bit skeptical of acupuncture, it seems to be that you are bringing your own bias to your analysis of this study. I think the methodology in this study is sufficiently flawed that it's unlikely that any useful conclusion can be drawn from it. It's wrong to assume that something is true without evidence; it's equally wrong to conclude that something definitely isn't true based on a badly designed study.
Bill said: Does anybody have any thoughts On "Intra muscular stimulation" which is sticking acupuncture needles into "shortened" or stiff muscles to relieve pain?
Maybe not the same, but there is a needle procedure to relieve small muscle cramps. (I remember the term 'trigger point', but not the context.) After misusing my shoulder I ended up with over 15 visible small knots in the muscle ranging from the size of a pea to the size of my thumb. Think of 15 miniature charlie horses. Bad enough that I ended up at the emergency room that weekend. The doc used steroid/anesthetic shots directly into the worst ones, and used a dry hypo needle into some of the smaller ones. My recollection of his explanation is vague, but the knots were the result of small groups of muscle fiber within the larger muscle mass tightening up, and that the needle entering the knot caused a reaction(?) to loosen them. No qi involved, and thankfully instant pain relief. Oh man, do I love doctors and anesthetics.
Really?
List your specific criticisms of this study that describe flaws that invalidate its results.
Yep, it's called physical therapy.
Is that were the needle is so small, it's not really there anymore but the air 'remembers' it's properties and confers effect onto the site of application?
And is this scientific... absolutely no it is not scientific, it is totally empirical.
I don't follow this. The essence of the scientific method is disproving hypotheses through empirical means. How can acupuncture be both empirical and not scientific? If it's based on empirical data, then empirical data could conceivably falsify the theory, so any thing based on empirical data is potentially scientific.
And if it is not possible to disprove acupuncture, why do Chinese doctors bother using it?
why Chinese practitioners believe western practitioners merely treat the symptoms of problems
Surely Chinese practitioners should look to their own cooking first? Before Chinese practitioners start getting uppity about other people's work, they have two questions to answer:
1) is my treatment effective?
2) does my treatment treat the symptoms or the problems?
If I understand your argument that acpuncture is not scientific, then those Chinese practitioners don't even know the answer to the first question, let alone the second.
List your specific criticisms of this study that describe flaws that invalidate its results.
It's not the results; it's your interpretation of the results. The results are these: both improved; in the short run, sham was better than real. In the long run, they were the same.
You conclude from these facts that the whole thing's mere placebo. But an equally valid interpretation is that "acupressure and acupuncture are both effective treatments; they are equally effective in the long run, but accupressure is more effective in the short run because patients don't experience the pain of being poked with needles."
You need a different experiment to test this hypothesis. But to toss the whole thing based on this study is remarkably shortsighted.
Never gone through acupuncture myself, but I watched my grandparents' dog go through it -- went from limping due to hip problems to bouncing around like a puppy in one day. German Shepherds are smart, but are they smart enough to experience a placebo effect?
I don't know about the ancient Egyptian battery, but the so-called 'battery' from ancient Mesopotamia has been thoroughly debunked.
No Babylonian electrical charges, thus.
Although it still pops up on the internet from time to time! There's no way to drive a stake through the heart of a pseudo-archaeological story. Or acupuncture, probably.
Visit Zenobia's website Empress of the East
Does acupuncture work?
Maybe short term, through the placebo effect. But long term? Uh uh.
My mother's a CRNA, and she laughs when people talk about acupuncture. She studied it when it first made a big leap across the Pacific in the 70s--who in anesthesia wouldn't be curious about a non-chemical alternative to gas'em'up Western methods? It didn't take long to realize the pitfalls of it, and she waved it off as a passing pseudoscience fad. The stuff doesn't do what it claims, or anesthetists and anesthesiologists would be using it, right now, for surgery. Physical therapists would be using it for chronic pain.
Thankfully, the stuff doesn't work. I say thankfully because I'm one of those people who freaks at the very sight of a needle, and that turns to terror if it comes towards my person--as in, to be stuck in me. Yes, I'm a baby, but I hate the dang things. I'll do anything to avoid one, and I never--never ever--look when I get a shot. I've had to be restrained to accept one, because I go into total panic mode around one.
So I'm trying to imagine getting dozens or maybe even hundreds of needles stuck in me, as happens in acupuncture. That is a horror beyond horrors to me. Why would anyone do that to himself? Don't tell me the needles are "small." F*@# that! No needle is that small!
"why Chinese practitioners believe western practitioners merely treat the symptoms of problems"
Ah yes, curse those western practitioners who merely treated the symptoms of my old man's prostate cancer with full surgical excision, or my sister's full-blown eclampsia with an emergency c-section, when what they really needed was some medieval pin-sticker to re-channel their qi.
I think folks may have the idea I am a Chinese medicine advocate. Not necessarily so, just defending the practice from what I see as a flawed study. So, to be fair what would be a good study? Get some real Chinese medicine practitioners and a control group of patients. Let the real Chinese practitioners treat the patients with acupuncture any way they see fit. Then let a western practitioner with a Chinese medicine book treat the control group with their "cookbook" of points. Compare the two groups at the end. From what I understand the Chinese medicine is very complex although it may seem cursory to somebody coming from the perspective of western medicine. But to counter an above point, nobody will dispute that for communicable diseases or emergency care, western medicine has advantages over Chinese medicine. But before someone seriously tags this group of practitioners as "sham" and before we begrudge the money folks spend on that form of care. Consider the amount of money spent yearly on just the two cholesterol lowering drugs Vytorin and Zetia, both relatively expensive and highly advertised medicines which some cardiologists now are saying that they do not work.
Regarding my comment on the 'Baghdad batteries' above, one of your readers wrote to me on my own blog asking for references backing up my debunking remark. In the interest of driving a stake through the heart, I take the liberty of posting two references here as well.
First, check out this 1996 article in the Skeptical Inquirer -- always a good resource on such pseudo-science problems: Gerhard Eggert, The enigmatic 'batteryof Baghdad'.
Also, try to find in the library: E. Pászthory, "Electricity: Generation or magic? The analysis of an unusual group of finds from Mesopotamia" (1989). In: Fleming, Stuart J. & Schenck, Helen R. (eds.), History of technology : the role of metals. MASCA research papers in science and archaeology ; v. 6. University of Pennsylvania: 1989, p. 31-38. Abstract: Discusses the magical meaning of metals at that time and suggests these objects, including the so-called "Parthian Batteries", were containers for blessings/incantations written on organic material (thus the papyrus in the Selecuia examples). Based in large part on Pászthory's article in German published in Antike Welt 16(1) (1985), pp. 3-12.
But before someone seriously tags this group of practitioners as "sham" and before we begrudge the money folks spend on that form of care. Consider the amount of money spent yearly on just the two cholesterol lowering drugs Vytorin and Zetia, both relatively expensive and highly advertised medicines which some cardiologists now are saying that they do not work.
Why? If acupunture is sham, then it's a waste of money, reagardless of how many other things may be a waste of money too. And it's rather ridiculous for any acupuncture supporter to start criticising any other medical treatment, when, if I read your earlier comment right, Chinese doctors have no idea if acupuncture even works (this is based on your statement about acupuncture that absolutely no it is not scientific).
I don't think much of these Chinese acupuncturists you talk about, they seem like total hypocrites, criticising Western medicine for faults that, if you are right, are absolutely inherent to their own practice.
Well, we probably won't agree on this, but I don't see the study as proving acupuncture as a sham. Although, I think from reading the method chosen, proving it as a sham was the intent.
provided traditional Chinese practitioners even subscribed to this theory, then at best you have dis-proven that theory alone. But only if the methodology was correct, I think it was not because to read the study literally, each of the subjects received either accupuncture or accupressure on identical points... whether the needle was dull or sharp and whether it penetrated or not. I don't see Chinese practitioners as hypocrites, I think they have no need to practice western medicine protocol. As far as a treatment being a sham because it is unproven scientifically, we just in recent years are learning about prostaglandins, why for example... aspirin helps with pain, and yet we have used aspirin for a very long time in the interim not knowing how it worked. Until we can fully understand pain medically, maybe we should be trying to learn why acupuncture seems to work for some people in some circumstances... and not be so bent on proving it to be a sham. BTW, my example of the statins is not unique, there is also a current renewed controversy about anti-depressants and both the efficacy of them and the methods used in proving them.
I don't see Chinese practitioners as hypocrites, I think they have no need to practice western medicine protocol.
By "western medicine protocol" you apparently mean "finding out if a treatment really works or not". In this case, I think Chinese practitioners do need to practice what you call "western medical protocols" (though I don't see what's particularly Western about considering that you might be wrong, and looking for some evidence one way or another). Your Chinese practitioners are spending time and money on treatments, they jolly well should know if their treatments are effective or not.
Considering the possibility that you might be wrong is a duty that all humans should follow, not just Westerners.
As far as a treatment being a sham because it is unproven scientifically
A treatment is not necessarily a sham if it is unproven scientifically. But if it has been through numerous tests, and still has not been shown to work any better than a placebo, then it's a sham.
It is entirely possible to have scientific evidence that something does work, without knowing why it works. I don't know why a moving magnetic field induces an electrical current, but I do know that it does. We don't have any evidence that acupuncture works any better than a placebo - that's the problem with acupuncture.
and not be so bent on proving it to be a sham.
Why not? If it's not effective, we can drop acupuncture from our list of research subjects and focus on other things.
You appear to assume that the world has unlimited resources, so it doesn't matter if Chinese practitioners waste their time giving treatments that they have no idea of effectiveness, and that unlimited research can be done into acupuncture, regardless of how much evidence appears indicating it is no better than a placebo. I think differently.
I don't see Chinese practitioners as hypocrites, I think they have no need to practice western medicine protocol.
By "western medicine protocol" you apparently mean "finding out if a treatment really works or not". In this case, I think Chinese practitioners do need to practice what you call "western medical protocols" (though I don't see what's particularly Western about considering that you might be wrong, and looking for some evidence one way or another). Your Chinese practitioners are spending time and money on treatments, they jolly well should know if their treatments are effective or not.
Considering the possibility that you might be wrong is a duty that all humans should follow, not just Westerners.
As far as a treatment being a sham because it is unproven scientifically
A treatment is not necessarily a sham if it is unproven scientifically. But if it has been through numerous tests, and still has not been shown to work any better than a placebo, then it's a sham.
It is entirely possible to have scientific evidence that something does work, without knowing why it works. I don't know why a moving magnetic field induces an electrical current, but I do know that it does. We don't have any evidence that acupuncture works any better than a placebo - that's the problem with acupuncture.
and not be so bent on proving it to be a sham.
Why not? If it's not effective, we can drop acupuncture from our list of research subjects and focus on other things.
You appear to assume that the world has unlimited resources, so it doesn't matter if Chinese practitioners waste their time giving treatments that they have no idea of effectiveness, and that unlimited research can be done into acupuncture, regardless of how much evidence appears indicating it is no better than a placebo. I think differently.
Late to the party, I know, but I'm going to have to agree with the poster who said you're just bringing in your own biases to this. You completely ignore the more important result of the study was that both sham and real acupuncture did better than the best that standard medicine has to offer! Oops.
Furthermore, even if this is just the placebo effect at work, so what? We need to learn all we can about why the placebo effect happens. And do you really think those with chronic pain care whether or not it's a placebo, as long as it works? I sure as heck wouldn't (being a chronic pain sufferer for ten years starting at age 16). Although it's a moot point there because acupuncture, like the standard medicine I went through for over ten years and counting, did nothing for me.
Some posters ranted about the costs. Costs compared to what? How much do you think I had to shell out for specialists, even under my gold-plated health insurance? My shot at acupuncture (after which the acupuncturist gave up) was less than 5% of the additional costs of treatment via the 100% effective, 100% understood scientific-community-endorsed methods.
Oh, and do you want to know what the evidence-based (hah!) health care system shuffled me to during this? A doctor who a) thinks any use of pain medication makes you an addict and a threat to others (due largely to his religious beliefs), and b) honestly believes that an "addiction" to a cheap prescription drug under supervision of a doctor, is worse than having severe pain and facial numbness clouding my thoughts all day.
So please, go ahead and rationalize all this, but if you can't do so with two giant needles jabbed into your back and neck (to simulate what it's like), realize how dishonest you're being.