I hate needles

(This post has been migrated from my old blog for reference. --PalMD)

But should you? Needles administering vaccines have saved millions of lives. Needles draw blood to help diagnose disease. They save diabetics' lives daily. Of course, they also help heroin addicts get high and catch diseases. So needles themselves must be good...or evil...or something...right?

To add more to the mix, an interesting study was just published in the Archives of Internal Medicine (Hakkke, et al. German Acupuncture Trials (GERAC) for Chronic Low Back Pain. Arch Intern Med/Vol 167(17), Sept 24, 2007, pp 1892-1898). This evil, Big Pharm-controlled tool of the AMA well-respected medical journal forgot to censor published a randomized controlled trial of acupuncture to treat chronic low back pain. It's actually quite clever.

The study took a large group of people suffering from chronic low back pain, one of the most common problems in primary care medicine, and divided them into three groups. One group received the standard German therapy for back pain (don't let your imagination run with that, please), which includes physical therapy and medicines like motrin. The next group got traditional acupuncture using well-established methods of practice. The last group received sham (fake) acupuncture--the needles were not inserted in locations determined by any theory of qi or meridians, and were not inserted to the usual depth. They were also not inserted in such a way as to arouse the "de Qi" sensation that is supposed to indicate correct application (or something). There was no control group that had no therapy at all, because that is just mean--but it would have been useful.
So, what happened with our needly friends?

The standard therapy group got a little better.

The acupuncture group got better than the standard group--about 1/3 better than before treatment.

And the fake acupuncture group? The same! They also got about a third better!

What does it mean?

The authors have an opinion--here's mine.

1. First, we just aren't very good at treating chronic low back pain. Despite it being a very common problem, our patients are still suffering more than we'd like (how much suffering would we like?).
2. The theories of Qi that underly acupuncture are very likely incorrect. They are scientifically implausible, but this study shows them to be statistically implausible as well. Sure, we can come up with excuses all day about why the sham and "real" acupuncture groups did the same, but the Qi is left in tatters. If just sticking needles in people's backs willy-nilly makes people feel better, then you don't really need to study ancient, complicated (and kooky) theories--you can, well, just stick people, apparently.
3. Something about sticking needles in people's backs, under the study conditions, makes people feel better. We need to figure out what.

So, needles are neither good nor evil. People who knowingly sell you unproven therapies are a different matter--perhaps more on that later.