I've at times been asked where I come up with my blogging material. Since I've become fairly popular, one major source has been readers sending me stories. I often don't have time to respond, and most of them don't interest me enough to be motivated to write, but there are enough that do that I consider my readers to be a major source of material. Then there are medical and surgical journals, as well as sources like EurekaAlert! Then there are my numerous RSS feeds that I peruse on a daily or every-other-day basis in the evening or early in the morning. Then, of course, there are the various websites with--shall we say?--a pro-CAM orientation. It was from one of these that I found a story that appalled me almost as much as the infamous "battlefield acupuncture" stories I've come across recently. Now, instead of subjecting our best and bravest to pseudoscientific woo, now they're subjecting another population that lives in conditions where they can easily be taken advantage of to placebo medicine:
Beyond the iron gate, the fence and the razor wire, 10 inmates in maroon uniforms sit in stillness, listening to the serene sounds of sitar music. Eyes closed, hands folded, they await the tiny pricks of acupuncture needles being inserted delicately in their ears.
Ancient Chinese medicine came to Baltimore's jail 16 years ago with the promise of curbing the cravings of drug addiction. Since then, acupuncture has been the centerpiece of a treatment program that serves nearly 700 inmates each year.
Modern science has not found solid evidence that it works. Still, the inmates claim that with acupuncture, all they crave are the meditative moments it brings. They say it soothes them and helps clear their cluttered minds to find the strength to confront their addiction.
"I've done buprenorphine and methadone, but neither one of them could compare to those needles," says Derrick Brooks, 42, who's battled heroin his entire adult life. "Those needles put you in touch with stuff that's within you that no pill or nothing else could do."
Here we go again...
In the case of the Air Force, it's a woo-friendly acupuncturist Air Force physician named Richard Niemtzow who wanted to bring acupuncture to the men and women under his command, evidence be damned, on the basis of a couple of very poorly done, unblinded studies and his "personal experience." This time around, we have an acupuncturist and judge:
District Judge Jamey H. Hueston thinks every addict should try it. "I am a huge fan of acupuncture," says Hueston, who presides over the city's drug court. "I have sent people in there kicking and screaming, resentful and scowling at me. And later they say, 'Judge, thank you.'"
Acupuncture is the key element of the Addicts Changing Together Substance Abuse Program administered by the city's drug court. Beginning for women in 1993 and for men three years later, the program steers nonviolent offenders to a rigorous 45-day behind-bars regimen in lieu of a longer prison sentence.
Lovely. I wonder if the reason has anything to do with the acupuncture or more to do with the much nicer conditions that the prisoners can expect if they participate in the program:
In addition to 25 acupuncture sessions, inmates get group and individual counseling, GED training and life-skills classes. Recently, the program added a family mediation option for addicts who long ago burned family bridges but want to mend them.
Participants reside in a separate dorm at the Baltimore City Detention Center, away from the general population, and are encouraged to rely on each other for support.
Gee, you don't think that all that training, life-skills coaching, and counseling, along with getting to live in a separate dorm away from all the other riff-raff living in the general prison population, have anything to do with it, do you? Naaahhh! Perish the thought! And it really coun't possibly have to do with how the acupuncture recipient then gets to chill out and sit quietly for 30 to 40 minutes after a session with lights dimmed and soft music playing to promote relaxation and meditation? No way! Needles. It's got to be the needles. And the woo. Don't forget the woo, namely the qi. Oh, and the endorphins, the usual "science-y" blather that acupuncturists use to justify their woo:
Eastern medicine experts say what is at work is not just New Age wishful thinking.
The treatment causes the body to release feel-good chemicals called endorphins, which go to the same receptors in the brain that are turned on when someone takes drugs, says Dr. Lixing Lao, director of the traditional Chinese medicine program at the University of Maryland's Center for Integrative Medicine.
The technique works to treat pain in the same way, says Lao, who works closely with Maryland Shock Trauma Center, treating patients who have been critically injured.
"The concept is very obvious," he says. "If acupuncture works for pain, it should work for heroin addiction."
Dr. Lao. Why did it have to be Dr. Lao?
We've met Dr. Lao before; he's the woo-meister who's brought reiki to one of the premiere trauma hospitals in the nation and has been spewing mystical nonsense about redirecting or unblocking the flow of a magical life energy that no scientist can detect in what should be a bastion of science- and evidence- based medicine. In fact, Dr. Lao is director of traditional Chinese medicine research at Maryland Shock Trauma, an oxymoron if ever I heard one.
But, hey, it's cheap, and it must be working, right? Surely the City of Baltimore must have data on the outcomes of these inmates after they complete the program. Surely officials must know how many of them stay clean after they get out.
Uh, no, not quite:
The state Division of Correction does not track inmates after they complete the program and does not keep data on whether addicts stay clean. But Mohammad Riaz Ahmad, the program's director, points to studies elsewhere that suggest acupuncture's effectiveness. A Yale University study found that 55 percent of participants tested free of cocaine during the last week of acupuncture treatment, compared with 24 percent and 9 percent in two groups that did not have acupuncture. But a follow-up study contradicted the earlier findings, and researchers said the topic needs more research.
Let me get this straight. The City of Baltimore is paying a firm $40,000 a year to provide acupuncture and it has no idea if it's doing any good helping imprisoned addicts beat their addiction? Way to go, Baltimore! As for the Yale study referenced, I couldn't find the original one, but I did find what appears to be the followup study. It's actually pretty good in that it uses a sham needling control in non-meridian locations and a relaxation alone control. True, that made it impossible to completely blind the study; so subjects were told that the study was comparing two kinds of acupuncture and relaxation to see which was better. Because it was a well-designed study, I bet you can guess what it found. At least you can if you've been reading this blog regularly.
Nothing. Nada. Zip. There was no difference between any of the groups. Also, a large meta-analysis done in 2005 found no effect due to auricular acupuncture on addiction treatment outcomes. True to form, the larger and more rigorously designed the study, the more likely it is to find no difference between placebo acupuncture and "true" acupuncture, and this study was no exception; but even worse, it didn't even find a difference between acupuncture and relaxation therapy.
So why not chuck the acupuncture and stick with the relaxation therapy? Easy! Relaxation therapy is boring and so...conventional.
Basically what we have here are advocates basically subjecting prison inmates to quackery and lying to them by telling them it will help them beat their addictions. I know, I know, they're not really lying because they truly believe that acupuncture helps. That doesn't matter; they're still cheerfully selling a lie to prisoners, and the City of Baltimore is being taken for a ride by true believers who spew confident claims:
"We are not saying it's curing addiction - there is no cure for addiction," says Dave Wurzel, a certified acupuncturist whose firm does the jail's treatments. "Just like there is no cure for heart disease or diabetes. All we are doing in addiction treatment is lowering the risk factor that this person will die today of his or her addiction."
Of course, as we've already seen, neither the Baltimore prison system, the city, nor Mr. Wurzel have a scintilla of evidence that acupuncture is doing anything of the sort.
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I still think sitar music should be counted as cruel and unusual punishment in itself. On the other hand, since most drug addition programs are similar failures, this one isn't half bad, compared to the one they just run out of town (literally) in my hometown due to the use of Scientology as main "tool".
An update to the Air Force acupuncture situation: I am an Air Force physician, and we were recently notified of an opportunity to complete a training course in acupuncture. This would be accomplished via an all-expenses paid trip to...Andrews AFB. Your tax dollars at work.
nice post, excellent summary.
I believe the pilot study was Arch Intern Med. 2000 v160(15):2305-12
Surprisingly, none of the accupuncture trials for addiction have focused specifically on opioid addiction. There have been trials for cocaine & nicotine addiction, but I don't believe there have ever been any controlled trials of accupuncture for opioid addiction. Not even an open-label study in humans. The closest thing I know is this: Am J Chin Med. 1986;14(1-2):46-50; which is a study in morphine-habituated rats.
For all the spouting about endorphins, they went and studied an drug addiction process that perhaps is less associated with endorphins and more with dopamine.
"If acupuncture works for pain, it should work for heroin addiction."
Of course! That makes total sense! Just like if aspirin works for pain, you should be able to use it for sexual dysfunction...right?
If I put a broken leg in a cast and it heals, I should be able to put it in a cast to cure poison ivy also!
True to form, the larger and more rigorously designed the study, the more likely it is to find no difference between placebo acupuncture and "true" acupuncture, and this study was no exception
and also true to form the woo-meister quotes the older, smaller, less controlled study fully knowing full well that there are later better controlled ones.
"Gee, you don't think that all that training, life-skills coaching, and counseling, along with getting to live in a separate dorm away from all the other riff-raff living in the general prison population, do you? Naaahhh!"
Exarrrctly. It's really unsettling how easily *variables* get tossed out in projects like this. As in, I had a tumor surgically removed, but it must have been the magical salve I applied afterward that really cured me of my cancer! Or these "detox" programs that involve everything from skin brushing to zapping to ice-cold baths to fruit juice. How on earth do the Woo-peddlers conclude that it's precisely their proposed combination of interventions that "works"? Like, could I cut out the zapping and just stick to the fruit juice and still be "healed"? Why, there's no way to tell for sure -- so the woo MUST be the answer.
I thought I'd join you in taking a poke at acupuncture:
Acupuncture has as much to it as Homeopathy.
In other words, nothing.
No definable mechanism, no real efficacy outside that of the placebo. And no ethical reason to be used.
An interesting post. I agree in some ways, disagree in others. Have you ever tried acupuncture, Orac? Some people swear by it.
I doubt acupuncture will have much of an effect on drug addiction, we agree there. But then what does? There is no cure for addiction, just like there's no magic bullet for cancer. We spend plenty more than $40,000 treating addiction with all kinds of therapies that might also not work. We also spend trillions making wars that don't make any sense. Are you as critical of those programs as you are of this one?
As a research scientist, I think it's not a terrible idea to try some "high risk" therapies - ones that might not work, but if they do there's a big payoff.
Have you ever tried acupuncture, Orac?
oh sigh.
To plagiarize skeptico;
There is a reason that randomized double-blind studies are used to determine the efficacy of therapies â personal experience is unreliable. Please donât tell us that your woo therapy worked because you felt better just after you were treated, unless you can explain why the improvement you experienced could not possibly be due to one of the following:
1. Placebo
2. Temporary mood improvements due to the personal nature of the treatment
3. Psychological investment of the patient in the success of the therapy
4. Misdirection
5. Incorrect diagnosis to start with
6. The cyclical nature of the illness (gets worse/gets better/gets worse/gets betterâ¦)
7. Other medicines the patient is taking
8. The illness just goes away by itself.
9. Release of endorphins (mainly with acupuncture)
I agree with your idea that we should try some high risk therapies. Its just that acupuncture is not one of them. Not only is it not an unknown, its been tested and tested for 30 years, and after initial confusion with placebo, its pretty damn clear that there is nothing else to support it.
As for being critical of other things, like wars...total non-sequitur. Superman could come here and wipe out everyone in the state of Virginia and if Orac didn't bother to comment on that, it still wouldn't make acupuncture any more effective or useful.
Some people swear the Earth is flat, too. Doesn't make them right.
Except acupuncture does not fit that profile. Based on the studies that have already been done, it is highly unlikely to have any effect at all beyond placebo. And if it does have such an effect, it is very small (i.e. subclinical) to a very high degree of confidence. High-risk, high-reward can make sense. High-risk, no-reward does not.
I love the way the judge admitted that he was a huge fan of acupuncture. I myself am a fan of a lot of things outside of my expertise.
@ Samurai Scientist
It's funny, I think a lot of Orac's previous acupuncture posts start with the mention that once upon a time, he thought there might be something to the whole 'acupuncture thing'. Not the business with energy flow and meridians, but that there might be some science behind 'being poked with needles makes one's head hurt less'.
Then he did some reading on it, looked at studies that compared acupuncture with being poked with non-needles in the wrong places, and noticed that they show the exact same result. That's a very good sign that the needles aren't doing much, and it's mostly in the heads of the people being poked (maybe not consciously in there, but in there).
Any time there's studies that show 'hey, if the people being treatment don't know whether they get the real thing, and the people they interact with don't know, we get similar results between the control group and the real group' that means that it's not working.
I tried acupuncture when I was a believer in such things. I swore it up and down that it worked. It had to, it was expensive. Once I had awakened to what a gullible slave to woo I had become, I saw that acupuncture was really not any more effective than a good nap. I really wanted it to work . . . and I'm an advertising creative director, so my job is making people believe things. Small wonder I drank my own Cool-Aid*. So, back in the day, I would leave environment of the ad agency (picture a box of screeching, stressed-out macaques on crack will cell-phones) then go to Dr. Sha's warm, dim treatment room with the tinkly music and the gurgling fountain. I'd rest for a bit, someone would care for me and ask me about myself and LISTEN to me. They'd stick needles in me and let me lie there for fifteen minutes. I would leave feeling refreshed and mellow (see nine reasons why in TechSkeptic's post above). The same was true for bodywork, reiki, and other assorted woo I used to swear by. Now I just go lie down or talk to someone I love or pet the dog or, well, you get the picture. Science works. Woo is wishful thinking.
*Apologies to that lady who doesn't like the whole Jonestown analogy thing, but works really well for me. And really, it was thirty years ago. Oh, and yes, I know it was actually Flavor-Aidâ¢.
Samurai
Keep reading Orac. He's an excellent evidence-based medicine commentator. He will actually teach you.
I say this because if you are going to call yourself a scientist you are going to have to learn to think using scientific tools.
Accupuncture is a fantastic topic to use to teach yourself EBM. And untill you learn EBM you will not have the mental tools to be able to comment on treatment effectiveness at a scientific level.
If you don't mind a little NSFW language, here's a pretty funny bit about an aromatherapist at a car crash...
I know you hate this sort of comment, Orac, but there is a "not" missing here, disrupting the sense:
"Nothing. Nada. Zip. There was difference between any of the groups."
Keep up the good work. Judging by SS's comments, there is still some way to go.
@Techskeptic, Becca, Pareiodolius (& Scott),
I appreciate your comments and have replied on my blog so my readers can get in on the convo.
@antipodean,
Keep reading Orac. He's an excellent evidence-based medicine commentator. He will actually teach you.
Here to learn.
I say this because if you are going to call yourself a scientist you are going to have to learn to think using scientific tools.
LOL
A lot more people swear by:
* Tobacco smoking,
* Lourdes water,
* Exorcism,
* ...
Therefore, by your argumentum ad populem they should be tried first.
I've said this before, but...
Accupuncture is damned by its own history. With 2,000 years of use, if "traditional chinese medicine" actually worked, we'd expect to have seen lifespans in China that were significantly above the rest of the world's for at least a thousand+ years. That simple observation ought to crater "traditional chinese medicine" for anyone who isn't a complete drooling idiot.
Samurai Scientist, read this:
http://www.amazon.com/Snake-Oil-Science-Complementary-Alternative/dp/01…
I think this may be my first post here. I stop by frequently and read, mostly woo friday. So here is something I hope they never experiment with. I found at huffPost. The science of distant Healing.
http://www.huffingtonpost.com/srinivasan-pillay/the-science-of-distant-…
They really believe this horseshit. Can you imagine. Next thing you know they'll be saying. Don't call an ambulance call on your own inate abilities. You can do it.
These people really piss me off. I am happy that we have such a vibrant internet presence of rational scientific awareness available. Thanks Doc.
@Marcus Ranum: I am not so sure that acupuncture really *has* such a long history as is commonly claimed. I have seen some ancient acupuncture needles in museums and they are huge and look nothing like the modern needles. I can't currently find a source but I am under the impression that it was resurrected from obscurity, and tweaked quite a lot, under Mao's regime.
Amusingly, the scams in China are all about (fake) western medicine...
SS reminds me of those evangalical Christians who attempt to proselytize on militantly atheist fora like Pharyngula assuming that the regulars there haven't heard "The Word" before.
Sid Schwab - I liked Billy Conolly's retort to the agrumeng from antiquity "It goes back ot ancient Egypt so does slavery but were are no f*ing bringing that back."
Cath the CC - Someone on the the Science Based Medicine Blog said that the practice of sticking needles in the earlobe originated very recently in France. If this is the case than it is neither traditionl or Chinese, just pulled out of someones ass in the 2Oth century. Whether this is worse than pulled out of someones ass a thousand years ago is a moot point.
May I recommend the book Trick or Treatment for everyone here. It has a good history of Acupuncture and a great history of how we recently got such great diagnostic tools like double blind trials.
Acupuncture in one form or another is very old and may not have started in china, but was certainly "improved" there, when vaccines were brought to china, their inclination was to inject them into acupuncture points.
TCM (chinese traditional medicine) is thousands of years old and most of it is nonsense (and horrible
Chiropractic is about 100 years old and started in america.
homeopathy is about 200 years old and started in germany.
All of these sCAM methods have one thing in common..no mechanism by which they work, no provenance, and poor results when studied properly.
There are more of course.
JamesR - PalMD is already on the case.
Thanks Bob
Have a great weekend.
Orac, you said Reiki is "redirecting or unblocking the flow of a magical life energy that no scientist can detect", but didn't a child demonstrate that Reiki practitioners cannot detect the "energy" either - they couldn't tell whether there was an arm under a cover or not ? I think it would be better expressed as
With the claim about endorphins helping the drug addiction, have people measured the levels of endorphins released during real vs sham acutpuncture ? Are the level changes biologically significant ?
Davidp
I think I know the study you are referring to. I'm not sure it was Reiki though. I think it was Therapeutic Touch: A healing modality used by some nurses for a time that involved neither touching nor any therapeutic benefit.
I have to agree with your modification of Orac's statement though.
Antipodean,
you're right http://www.quackwatch.org/01QuackeryRelatedTopics/tt.html