It works!

Many alternative treatments have been around for a long time and have never been shown to work above the placebo effect in quality clinical trials. Yet, there seems to be a constant supply of news items and press reports claiming that researchers have found that they do actually work, it has just never been known how.

Recently (May 2005) we have had two reports within three days. One report claimed that real and sham acupuncture produce exactly the same results (i.e. acupuncture is nothing more than a placebo), the other claimed that acupuncture works beyond the placebo effect, and a new mechanism has been found which explains it. Why is there a discrepancy?

A look at the trials:

1. One trial stated that acupuncture, whether real or fake (fake acupuncture involves inserting needles in non-acupuncture points), produces the same results in patients. This is now widely accepted to be true as several trials come to the same conclusion. This means that the mystical elements of acupuncture such as "Qi" and "Yin and Yang" and the physical "meridians" cannot be true.
   
   It is also strongly suggestive that a placebo effect is responsible for the reduction in symptoms, although this does not rule out any possible real effect due to needling, as needling takes place in both the real and sham treatment (see: Fake acupuncture 'aids migraines').
   
   This trial, as with other similar trials, concluded that acupuncture works by the placebo effect and nothing more.
   
   
2. The other recent trial claims to have found a new mechanism by which acupuncture may work (see: Acupuncture activates the brain).
   
   Again, real acupuncture was compared to sham acupuncture. The sham acupuncture this time, however, was done with needles that look like real acupuncture needles but that are retractable and do not penetrate the skin.
   
   The researchers scanned the brains of the patients (using PET scans) to see what effect was happening. It was found that whether real or sham acupuncture was given, the area of the brain which responds to endorphins, the body's own natural pain killers, was activated. This finding supports the theory that the placebo effect works (in pain relief) by the release of endorphins in patients who expect the treatment to offer pain relief.
   
   The main finding of this trial was that an area of the brain known as the "insula" is activated with real acupuncture and not activated with the fake acupuncture. This finding led to the claim and subsequent headline: "Medicinal use of needles does more than placebos".

Does this new finding confirm that acupuncture works?

The key to understanding this is this quotation from the second example: "True acupuncture also increased activity in a different brain area called the insula, which is part of the cerebral cortex. It's not clear what this activity means, says Lewith, but it indicates some sort of real effect."

NOTE: "It's not clear what this activity means".

The difference between the real and the fake acupuncture is that in the real acupuncture the needles penetrated the skin; in the fake acupuncture the needles did not penetrate the skin. A reasonable conclusion to draw would be that the insula is activated when skin is penetrated, not that acupuncture works better than placebo.

This does not validate acupuncture in any way at all. It cannot do so until the function of the insula is determined. Although this is a new finding, the effect must always have been there in patients. This does not explain why real and sham acupuncture (of any kind) always have the same effect in patients; the placebo effect, however, does.

What is going on here?

The discrepancy between the findings of the two trials is caused by the fact that many people, some of them scientists, want to believe that things like acupuncture, homeopathy, reiki, and such like really work. What can happen is that even scientists doing very well designed studies can come to false conclusions. There may be no fault with the experimental design or method, it is the conclusion they form from their results that can be wrong.

The logical fallacy of "drawing the wrong conclusion" (see: Ignoratio Elenchi) can occur. In this case it has been concluded that the difference between real and sham treatment is down to acupuncture working, whereas in reality there could be other, more likely, conclusions drawn.

There is also the fact that once results are published, they can be hyperbolized by over enthusiastic, uncritical reporters.

Whilst the trial in the second example above may have found a new phenomenon that may be worth investigating, it has not proven that acupuncture works above the placebo effect.

Conclusion.

There is an almost endless stream of reports claiming that "Treatment X" works. Research is always useful as new mechanisms may come to light that can explain how a treatment may be beneficial. The problem, however, lies with the hasty conclusions drawn from such research and the uncritical reporting of the findings.

New findings may show up the need for further research, but the reported claims of the conclusions drawn from them are usually exaggerated or completely unfounded. Unfortunately, many of these reports are seized upon and offered up as proof that something has been found to work even though it has failed numerous trials in the past.

As shown in the example above, we need to scrutinise the claims made and look for false or exaggerated conclusions before accepting them.