Your pain means nothing to me.

Pain is subjective. It is highly personal, different for every person. Hospitals have pain charts with number scales and facial expressions as indicators of pain for verbal and nonverbal patients. If you’re intubated (a breathing tube down your throat) you can’t speak. Though uncomfortable, you may or may not be medicated enough to experience pain. You will want a nonverbal pointing chart to tell your doctors to increase or change the meds. When people ask if getting tattoos hurt, I tell them no. Not really. But I know people who found getting their tattoos excruciating. Why? Pain is personal. It is this very subjectivity that confuses people when talking about sCAMs (Complimentary and Alternative Medicine). “Acupuncture took my pain away!” is a frequent anecdotal response. The data is clear – when done in a proper, double blinded study, acupuncture performs no better than placebo or sham acupuncture (twirling randomly placed toothpicks). Someone who practices acupuncture obviously doesn’t understand or care about modern medical practices (or more likely they willingly reject facts). If the practitioner believes in ancient magic (nonscientific), then they don’t necessarily understand or embrace germ theory (scientific). Why risk having them stick needles in your body if you get the same effect with toothpicks?

A good friend of mine had both of his legs broken when he was run over by a car. For personal reasons he didn’t want opiates or other narcotic painkillers in his recuperation, so he relied on a meditation practice he learned as a teenager. When he talks about what he used to mitigate his pain he says that white light healed him. When I go on the attack against sCAMs he is often the first person to point out his personal experience with acupuncture and meditation. He says that it healed him. What is very hard to teach is that healing is different than pain. The human body evolved a hardy immune system and a self-repairing mechanism that work very well. As such, the body itself does most of the healing. Pain is different. Pain creates stress, stress causes the release of cortisol by the adrenal gland, cortisol inhibits healing. If we can lessen pain we can create better conditions for the body to heal itself. Now, there are all sorts of things that the body can’t heal, or if interventions aren’t done will result in death. But as a general statement if those emergency interventions or stabilizing methods are successful the body repairs itself. Skin stitches back together. Organs resume function. Waste is processed, antibodies produced, white blood cells do their job, and so on. Pain has nothing to do with healing other than getting in or out of the way.

Accepting that this is how things work, “What’s the harm?” is the answer the believer gives to going to acupuncture, certain chiropractors, or other sCAM practitioners. There are a number of harmful things. The first harm is that because the modality is based on the placebo effect, if the treatment doesn’t work the practitioner blames the victim for its failure. Because there aren’t replicable mechanisms there isn’t any reason they will work. For most people just being talked to nicely and made comfortable is a way to mitigate chronic pain. It’s the failure of a lot of doctors that they do not have time or the inclination to listen to the needs of their patients. That’s bad bedside manner and diagnosis, not a failure of medicine. The sCAM practitioner comes from a background that teaches listening. The whole body approach is something often missing from modern medicine. But just because a practitioner lights some candles or spends a few minutes listening to the client detail their pain history is no reason to assume their modality is effective. The data shows it’s not. If the modality fails to have an effect the practitioner doesn’t know why, so it must be the patient’s fault. They should come back again and see how the next session goes. There’s a lot of money to be made in promising “maybe the next time will help”. And because there isn’t an actual mechanism at work the practitioner just keeps trying different guesses until the patient gives in, leaves, or convinces themselves it’s working. That is the placebo effect at work.

The second harm is that the sCAM practitioner believes that what they are doing is healing, as opposed to placebo effect to mitigate pain. This means that all too often you will find sCAMs being touted as a panacea. Take a look at a sCAM practitioner’s menu of cures. It’s amazing what they say it will fix. Some countries have laws about the language that can be used when making these claims so the advertisements are a careful dance around “cure” and “treat”. The rundown for acupuncturists, chiropractors and their ilk often looks like this: Low Back Pain, Headaches, Neck Pain, Shoulder Pain, IT Band Syndrome and Knee Pain, Shin Splints, Carpal Tunnel, Tennis and Golfers Elbow, Sciatica, Plantar Fascitis, Migraine, Digestive Pain, Poor Sleep, Obesity – the list goes on. What these things have in common are chronic pain that can be induced by repetitive motion, lack of physical strength or complimentary exercise, lifestyle choices, or completely subjective interpretations of pain and injury.

Let’s take migraine for example. A migraine is a specific neurological event with a cardiovascular component. There are drugs (tryptans) that only work if someone is in a classic migraine because these chemicals operate strictly upon brain chemistry. “Excedrin Migraine” is not an anti-migraine drug. It’s caffeine and acetaminophen. If taking Excedrin Migraine alleviates your headache, you weren’t having a migraine; you had a headache. However, caffeine is a vasoconstrictor, and a migraine can be the result of dilated capillaries. Dilated capillaries lead to headaches, which can trigger a migraine. It is possible that taking Excedrin can prevent a headache from becoming a migraine. Calling it a migraine formulation is misleading. Anyone who has experienced a full-blown classic migraine can tell you – an Excedrin isn’t going to cut it. Can acupuncture treat migraines? Only by a stretch of the imagination. If getting an acupuncture treatment helps you to relax, then sure, maybe it will prevent you from getting a migraine that day. An Excedrin is a hell of a lot cheaper and you know how it functions. Acupuncture? Not so much.

Obesity is another area with which I’m familiar. Obesity is more often than not the result of lifestyle choices. Chances are if an obese person goes to a sCAM practitioner they will be given some sort of “treatment” and told to adjust their diet. “Oh, you should cut out wheat and sugar because your Chi is blocked by those substances.” Well, no shit. Cut out wheat and sugar and you’re carving out most processed foods and high calorie items. This isn’t rocket science. Eat less, move more. The needle pricks at $150 a session aren’t the reason you’ll drop weight.

The confusion of magic and mechanism are a rot in the mind. This rot spreads into other areas of thinking like politics, religion, and lifestyle. I believe this rot leads to cognitive dissonance, the discomfort of holding two conflicting ideas at once. I had a friend with a deeply religious background who, for a time, believed in both the Adam and Eve bible story as literal truth and the evolution of man from primitive forms. She grew up taught that young earth creationism was true. As an adult she learned about evolutionary biology. But there were many years where these conflicting ideas battled in her mind and for some time there was a chimera of both realities existing at once. This is cognitive dissonance.

I believe in reason championing over magical thinking. I don’t think the way to convince people is to hammer them with facts and figures, statistics and data. We’ve seen time and again that people will reject facts when it doesn’t fit their worldview. Someone who believes that sticking needles into their skin somehow creates healing isn’t going to suddenly change their mind because they read a study showing it has the same effect as being poked with a toothpick. Instead, the key is to locate the source of their cognitive dissonance and amplifying that discomfort. For example – someone who believes in magical healing is probably likely to trust the scientific method unconsciously when it is a convenience. They may take aspirin, or a cholesterol-lowering drug. They use chemistry in their kitchen, or they use a cleanser product to clean their home. These are all things where we didn’t just stumble upon a method or solution. We discovered them, tested them, and re-tested them. The believer has drawn an arbitrary line somewhere in their mind and that line can slowly be moved. They move the line when asked to make a choice, and those choices are different for every person.

Science vs. belief is a false dichotomy; science is a process, not a belief system. I find most scientists to be more open minded because they are used to the strange feeling of new data reshaping their worldview. To be a scientist one must be open to new theories challenging held assumptions and, if proven, altering the field and their own work. (In fact, in order to earn their PhD scientists must, in a sense, alter their chosen field.) The science of sport has changed dramatically over the decades as new tools are developed. Witness the fundamental shift and achievements since the adoption of periodization. (And now digest the absurdity of the Church of Christ, Scientist, which does not believe sickness and death are real. Great magazine, dangerous and deadly belief system.)

Your personal experience is not a data point. Anecdotes aren’t facts. They are beliefs, they are memories, and they are flawed because you are human. In order to test something we must be able to isolate it and discover its mechanism. There must be a reason for change to occur. It’s even possible to see change without understanding the mechanism, but if it’s not replicable or falsifiable, it’s not real. Pain is real, but it is subjective. That is why it is an exploitable target for the con artists, frauds, and outright enemies of progress towards real treatment.

When I say that your pain means nothing to me, obviously I am lying. Your pain means everything to me, which is why I fight for evidence-based treatments that will stop pain – forever.

16 responses to “Your pain means nothing to me.

  1. ohhh…so many things that this makes me think about. My comment will probably be much too long.

    1)CAM…when referring to Complementary and Alternative Medicine yet you actually mean acupuncture/chiropractic/homeopathy, I personally think you should call that out. My reasons are personal(and yes I understand I am a data point of one)..mainly because it would have been what you would refer to as a CAM, who was a nutritionist who figured out my nutritional deficiencies and hence cleared up my depression with a simple blood test that confirmed I was low in folic acid. Folic acid is considered a CAM for depression. Meanwhile my psychiatrist tried to force prescriptions down my throat without even doing a few simple blood tests and warned me that exploring other options would just land me back in his office. My ‘treatment’ is considered a CAM so yes out of personal reasons I find the approach you take to claim that ALL CAMs are scam a bit over reaching. While some studies have shown that folic acid might be a good antidepressant prevention, it isn’t rigorously studied. Why? Because there is no money in it. Acupuncture is a type of CAM, but not all CAMs are acupuncture. And no…i don’t think ALL herbal/vitamin/ect CAMs are worth their weight either, but many ‘natural’ CAMs are not rigorously studied in the US because of the lack of ability to patent. Some are utter garbage, but some have some merit…yet they are still considered a CAM.

    2)”The first harm is that because the modality is based on the placebo effect,”
    I have a bit of a devil’s advocate comment on this one…Yet there are drugs on the market that are barely better than the placebo effect…so those are OK? There is a hot debate over whether or not antidepressants are any better than a placebo. JAMA. 2010 Jan 6;303(1):47-53. PLoS had another meta study in 2008. What is the right criteria for things being on the market and acceptable? I’m not arguing for or against what you put forward on acupuncture, but my academic question is: what IS acceptable? at what point is a treatment (pharmaceutical, or otherwise) reasonably acceptable?

    3)”Because there aren’t replicable mechanisms there isn’t any reason they will work” I have seen you write this in a few places about mechanism. In science we have hypothesized mechanisms. A mechanism cannot be proven…it can only be disproven. A particular hypothesis of a mechanism will gain acceptance that it is that particular mechanism for something when it is repeatedly tried to be disproven and cannot…but this does not mean that this is *actually* the mechanism. It is believed that some depressed individuals are due to low serotonin levels. And yet there is a tested antidepressant on the market that *lowers* serotonin levels. That’s a bit weird…food for thought.

    3)”In fact, in order to earn their PhD scientists must, in a sense, alter their chosen field.” Really? I wholly disagree and I know many, many a grad student turned Ph.D. who would also disagree. Publishing a few papers in a given field on some interesting findings does not in anyway alter the field. We all go in with high hopes of publishing that seminal paper in a field that alters it, but that is not the reality. But thanks for making me laugh.

    4)Your trust in the science process outstrips mine by a long shot. The more I learn about science, the more science I do, the more scientists I meet, the more papers I read, the more studies I see conducted only confirm to me that we know less and less than we ever thought possible. I’m more amazed every day that we have cars that run, electronics that work, cleaning solutions that clean, and that we actually can cure some particular maladies with chemical in pill form. I’m amazed particularly due to the fact we understand so little.

    Don’t get me wrong…i think science is amazing and tries to answer some very difficult questions. My commentary is not about acupuncture, chiropracic, homeopathy…ect. My commentary is more on some of the details of your argument.

    • I LOVE it when rocketpants replies!

      1) sCAM refers to more than just acupuncture, some chiropractic, and homeopaths. The list is long but also includes aromatherapy, Ayurvedic, improper use of chelation therapy (which is an actual therapy but abused by the sCAM world), different variants of “Chinese medicine” which is a wide blanket, some forms of herbalism, reflexology, iridology, magnet therapy, Reiki, and on and on. There is a name for alternative medicine that works: medicine. Your particular experience was with a bad doctor. When we talk about these things we have to have separate discussions about effective treatments and quality of doctors. It is very much like the Big Pharma discussion – major drug makers have their Dr. Jekyll who uses rigorous testing to develop effective drugs which are tested under strict, common guidelines. Mr. Hyde is their business practices, marketing, and capitalist behavior. Mr. Hyde would love to hack apart the constraints that Dr. Jekyll has to work under because then it would allow him to run the show. Thankfully, the FDA does an OK job of regulation. But there are a lot of Mr. Hydes working to whittle down those rules. Contrast this to the sCAM world, which is nothing but Mr. Hyde. They can make any claim without proving any efficacy. Believe that the Dr. Jekylls would love to operate that way. So your bad doctor wanted to shove SSRI meds down your throat unnecessarily. That sucks. You had a bad doctor. As for your folic acid treatment, there’s money to be made in it which is why it’s sold at GNC. More to the point, sCAM practitioners tend to sell their own “formulation” of things in order to maximize their profit. Tinctures, teas, and supplements are all profit making items for the snake oil salesman. Folic acid actually does something, but it’s not free. Yes, there is more profit in a patented SRI. But I reject the idea that no research is being done on folic acid used for treating depression because there’s no money in it. PubMed shows more than 490 articles on the subject including longitudinal studies. Clearly, data is being gathered and efficacy is being tested.

      2) I think this is your best point: What is our threshold? I’d be delighted if this was the conversation we were having. But presently we’re still talking about how much insurance money to pay to homeopaths for selling expensive sugar pills. I think Dr. Bubbles is right in his comment, placebo has a place in medicine but only used under certain conditions. Allowing people to be lied to creates a culture of fraud. If you believe, as I do, that we must provide health care to have a healthy society, then we must make decisions about what that health care looks like. I want people to get effective treatment and I want to stamp out the frauds and hucksters who are looking to reap fortunes off their snake oil or lies. Because once we start having a national health care discussion I’m being asked to pay for these modalities. The UK’s NHS is an excellent bellwether for these problems.

      3) OK, here I am making a language choice for ease of reading as opposed to scientific specificity. You are right, but it’s a harder sentence to write a series of negatives. Circling back to SSRI (Selective Seratonin Re-uptake Inhibitors for the readers), we don’t fully understand exactly how SSRIs operate in the brain but we do know from observation, testing, and having others replicate those studies that it does do SOMETHING. It doesn’t make your skin purple. It doesn’t make your hair fall out. It does help certain individuals with depression, and has helped enough people in blinded studies that we know the drug has a specific enough effect in a statistically significant way. The same can be said for statins which clearly have an effect on cholesterol levels. They also have other interactions, some less good, which is part of their action on the body. But there is an *observable, statistically significant effect*. The same cannot be said for sCAM modalities. And again, when I say sCAM I’m using a big paintbrush to smear a lot of disciplines.

      3) This is a subjective argument. Altering a field can be extraordinarily minor. Yes, it’s possible to earn a PhD by publishing a few papers in a given field on interesting findings and say it doesn’t alter the field. Yet, if it confirms an existing theory or counters another, that is now another brick in a large foundation. I’d call that altering the field. Diminishing the small parts denies the cumulative effect of the work. We have the totality of knowledge we have today because of many small steps and a few giant leaps. The giant leaps must still be backed up by testing and verification. I know it’s easy to mock achievement once done, or to look back on the work and see how the institution stymied progress, or the work was turned into something else, something politically motivated, or even became damaged. But the idea that it didn’t alter the field is a way of diminishing the impact that millions of small efforts yields progress.

      4) You’ve just reversed (in a good way) the god of the gaps argument. I wish that young earth creationists were smart enough to see that the best way to depress a scientist is to point out that every discovery they make creates room for at least two more discoveries. Discovery is like fighting a hydra – once you’re able to decapitate your particular problem you’ve created a space for two new problems to arise. Thankfully, it’s someone else’s problem and you can walk away with your particular dragon’s head. We should be amazed when we see complex, designed systems function. A car is a spectacular feat of engineering that we take so much for granted that we identify it with our own bodies. “Hey! You hit me!” we yell. When I see exploded schematics of an automobile, the pulled apart blueprint for all the different components, it makes me agog with wonder. It’s the result of decades of engineering developments. Ideas, theory, testing, deployment, refinement. We live in an amazing time of discovery and invention – real things. Why are we stuck with a belief in magic? Do I trust science? Not blindly. Do I think that it’s the best system we’ve come up with for testing and deployment of new ideas? Absolutely. I trust it with my life when I take medications to get rid of my migraines, when I get into my car to drive to a job, and hell – I make my living off fixing the errors in imperfect systems. That’s why I say that science isn’t a religion, either. Religions don’t change.

  2. Stopping pain forever is the goal, of course, but the person in pain now still needs to be helped now. Medical pain management, for a variety of reasons, doesn’t always result in the easing of pain. Would you just have the sufferer suck it up? Agreed that anecdotal evidence is not data; but neither is an individual person a sample or a population.

    I don’t go in for sCAMs myself, but I know people who do: people with chronic pain who have not been helped medically but who, for whatever reason, report less pain after sCAM treatment. So what if it’s just a placebo effect? It’s still an effect (one that has been inexplicably strengthening over time, too), and with respect to pain, at least, doesn’t the effect matter more than the cause? I’m unaware of any pain treatment that affects all recipients, and I’m also unaware of any way to determine, independently of the treatment itself, whether a specific treatment will affect a specific person. So the data show a greater likelihood of treatment X working on a specific person than placebo: but if it doesn’t, you can’t deny them the chance to find relief through the placebo effect of treatment Y simply because it’s less likely to work than X. Even in medicine they don’t reject less-likely options after more-likely ones were unsuccessful. (And, yes, I’ve even run across docs who wish it were ethical to prescribe a placebo in some situations.)

    I’m only thinking of pain management narrowly here, not other sCAMmy claims or how someone might think of health care matters overall after sCAMs eases pain that medicine didn’t.

      • Yes, well, the fact still remains that, for whatever reason, some individual people do perceive that things that don’t work in general do work for them. And you avoided my question of whether an individual should just suck it up rather than trying to see if something works for them.

    • I have seen people in chronic pain and I would never tell them to suck it up. That is hopeless. Untreated chronic pain can lead to severe depression and even worse situations. I once sat on a jury trial for a woman who was hit by a car and because of her chronic pain resulting from the accident she became addicted to painkillers. Of course, these had diminishing effect over time as all opiates do, and eventually her marriage and life suffered terribly because she was in a deep depression, addicted to painkillers, and still without ease of her chronic pain. To directly answer your question – no, I would not tell someone to suck it up. But if I were their doctor I would attempt to work with the patient to find a solution to their pain. Because pain is subjective it’s highly individualized, there is no one blanket treatment. In some cases a meditation practice can help as we’ve seen that individuals can self-stimulate the body’s own painkilling hormones. Ultimately, though, whatever the modality, it’s critical that the doctor or doctors treating the patient work in concert with each other to discover the root cause of the chronic pain without necessarily blaming the patient for their condition.

      • “But if I were their doctor I would attempt to work with the patient to find a solution to their pain. Because pain is subjective it’s highly individualized, there is no one blanket treatment. ”

        If you accept that this is true, you should understand how difficult this makes it to design experiments to test methods of pain relief. What works on one person might not work on another. Guess what that does for your experiment? If something only works on half (or less…) of your sample, then it is unlikely that you’ll get a significant effect overall. Then unless you can find a good distinguishing reason why it only worked on the people that it worked on, well, too bad.

        Maybe you need to answer this question: Would you tell someone suffering from chronic pain that they shouldn’t try acupuncture? That you are certain that it would do them absolutely no good?

  3. I challenge you to back up this statement with data: “The data is clear – when done in a proper, double blinded study, acupuncture performs no better than placebo or sham acupuncture.” Here’s a seemingly reliable review article I found quite easily reporting all sorts of interesting effects of acupuncture: http://ecam.oxfordjournals.org/cgi/reprint/2/3/315

    • “Interesting effects?” You’re asking me to refute one inconclusive paper with another paper. I can do better. Sciencebasedmedicine.org has a number of doctors, some of whose specialties are chronic pain treatment, cancer, neuroscience, and infectious diseases, doing line by line readings and briefings of peer-reviewed articles with a treasure trove of links to a vast number of articles. Start here:

      http://www.sciencebasedmedicine.org/?cat=8

      Your “interesting” conclusion is a gross overstatement of the metastudy’s data. “Therefore, while it appears that it is probable that acupuncture-like
      stimulation of UB67 triggers specific activation of the occipital cortex, it is by no means a uniform and consistent finding” And that’s using a soft laser, too, which means you don’t need to stick needles into someone to get an effect. AND “However, in pain a far less specific response emerges containing overlapping neural substrates activated by both placebo and expectation.”
      and “The effects of acupuncture in pain and possibly also in addiction may be far less point-specific as has been previously suggested from the
      available clinical evidence”

      Really? This is the big gun? Puh-lease. It’s yet another metastudy saying more research is needed.

      Confirmation bias is intentionally seeking out conclusions that support your pre-existing idea. Are you sure that you’re looking at this study in the broader context of the constellation of data?

      How about this – if you believe the hype, acupuncture quacks have had 4,000 years to refine their work and get it perfect, replicable, and statistically significant. The best they can manage is “interesting effects”. Western medicine has developed better methods in 100 years than needle pokers have in 40 CENTURIES.

  4. Ok, now this is just sad. Let’s start with your last sentence: “Western medicine has developed better methods in 100 years than needle pokers have in 40 CENTURIES.” Such as? What exactly does western medicine offer people who suffer from chronic pain?

    And talk about confirmation bias. Stop reading sciencebasedmedicine.com if you are concerned about people with confirmation bias. Where are the line by line readings you are referring to? A treasure trove of articles? A treasure trove of snarky shit. From what I read, they don’t actually refute anything, they just disagree with results published in respected peer-reviewed journals. Remember those, Max? They exist in the process of science that your evidence-based medicine is supposed to follow. Bloggers bitching about quality of the articles they disagree with doesn’t really count as part of the peer-review process.

    • The list of achievements of pain management is long and varied from electrical impulse interruptors to surgical interventions to psychiatric assistance and into drug developments. Sometimes it also means going out and doing complimentary exercises to strengthen weak areas. Sometimes it means surgery to correct congenital defects. Diagnosis of the pain has advanced which means addressing true cause has advanced. It’s not perfect, but it’s better reasoned than being given a fetish bag and told to pray or being jammed with needles and told your magical energy flow is blocked by a demon.

      The only interesting thing I’ve read about acupuncture havig any merit whatsoever comes from this item: http://www.nature.com/neuro/journal/v13/n7/abs/nn.2562.html
      “Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture.”

      So at best if acupuncture has an effect it’s the same as being jabbed with a toothpick until you get the A1 binding action. How about not blindly jabbing people with needles and develop drugs that more reliably target and address the pain?

      SEPTEMBER OF THIS YEAR, acupuncture for osteoarthritis of the knee:

      http://www.ncbi.nlm.nih.gov/pubmed/20506122

      CONCLUSION: TCA was not superior to sham acupuncture. However, acupuncturists’ styles had significant effects on pain reduction and satisfaction, suggesting that the analgesic benefits of acupuncture can be partially mediated through placebo effects related to the acupuncturist’s behavior.

      LOW BACK PAIN

      http://www.ncbi.nlm.nih.gov/pubmed/19433697?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

      CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.

      There’s a difference between the unwashed masses blogging (like myself) and people who are experts in their field analyzing and reporting. The snarky tone is because these practitioners of actual medicine are under constant attack by believers in magic. Their tone shouldn’t discredit their work and they always cite primary sources available at PubMed or the other searchable libraries.

  5. Your list of the options provided by western medicine to sufferers of chronic pain is pretty weak. It’s pretty much: cut it out/off, talk to a somebody who might convince you it’s not as bad as you think, or take an opiate. Guess what? None of those things were invented in the last 100 years by western medicine. I can’t say I’m familiar with “electrical impulse interruptors” but my bet is that if it worked a lot better than acupuncture then people with chronic pain would be giving it a try.

    This is getting silly. You provide me with links to studies whose authors conclude that there are genuine effects of acupuncture and want to study it further. You interpret that as meaning that acupuncture is a scam. WTF? Are you even reading what you are quoting?

    Then you suggest that acupuncturists (“believers in magic”) are persecuting MDs. Can you provide some evidence to back up that seemingly wild claim? Especially when the opposite seems more likely to be true, at least given the sources you are citing.

    “Their tone shouldn’t discredit their work”. I would think that a writer like you would appreciate the importance of tone establishing and maintaining a writer’s authority.

    Why are the sciencebasedmedicine freaks more expert in their fields than the authors of the published papers they are criticizing? Shouldn’t they be sending their criticisms to the journal editors rather than ranting on their blog?

    I’m not a proponent of acupuncture or a disbeliever in western medicine. Amazing things have come from western medicine (e.g., anesthesia, vaccines, antibiotics, etc.) and no one serious is claiming that acupuncture is a panacea. But Max and the sciencebasedmedicine guys are making one of the most basic errors in interpreting scientific results. They are accepting the null hypothesis.

    There are so many reasons that experiments fail to find significant results. In the case of the acupuncture studies, it could be that they didn’t use a large enough sample, that measuring pain is very difficult and noisy, that the control condition wasn’t good, that they didn’t wait long enough (or they waited too long) for the treatment to be effective, etc.

    Or maybe it is the case that acupuncture has no effect. But you can’t conclude that based on the literature. That’s just basic science. Eventually, when the amount of studies reaches some critical point where everyone can agree that no amount of further study is likely to find an effect, we can essentially accept the null hypothesis. But we are nowhere near there with acupuncture.

    I don’t think that many of the claims of acupuncture have been verified experimentally. And I certainly wouldn’t be surprised to find that a lot of the claims are never able to be verified. But that’s a long way from proving that acupuncture is a scam.

  6. “Your list of the options provided by western medicine to sufferers of chronic pain is pretty weak.”
    That’s a subjective argument. Refinements and developments have been made and you either refuse to acknowledge them or ask me to brief you on the last 100 years of medicine. You’re either being willingly naive, argumentative, or moving the goalpost for your definitions.

    “It’s pretty much: cut it out/off, talk to a somebody who might convince you it’s not as bad as you think, or take an opiate. “
    You can interpret it incorrectly that way or read what I wrote. Opiates aren’t the only drug interventions. Amputation is your misstatement of what I said was surgical options. Someone with a bone growth that is found to irritate the sciatic nerve has it shaved down – this isn’t amputation and it eliminates their chronic pain.

    “This is getting silly. You provide me with links to studies whose authors conclude that there are genuine effects of acupuncture and want to study it further. You interpret that as meaning that acupuncture is a scam. WTF? Are you even reading what you are quoting?”

    I’m not reading that there’s anything different about their findings over and over again. Studies come back with results no different than placebo. Saying it needs more study is a dodge. Enough already. They can say it needs more study because it’s the only logical conclusion they can make in the confines of their findings. It’s the agnostic viewpoint – nothing found here, keep looking. I’m saying enough looking, go do it on your own dime and don’t ask me to include this crap in a national health care system. This is the reason I’m even discussing this – I will not pay for pointless modalities so believers can feel better. Take a sugar pill.

    “Then you suggest that acupuncturists (“believers in magic”) are persecuting MDs. Can you provide some evidence to back up that seemingly wild claim?”
    Are YOU even reading what you’re writing? Read your last comment – I’m pointing out that real doctors are attacked in the press by sCAM practitioners because by dragging enough pseudoscience into real science they lower the bar for real treatment.

    “Especially when the opposite seems more likely to be true, at least given the sources you are citing.”
    I appreciate it when people stand up for what they believe in, and I also appreciate intellectual superiority when it’s well founded. Call hucksters criminals and prosecute them. Drive them out of town and make them unwelcome. I’m all for vilifying sCAM practitioners by revealing their underlying profit motive and they general practice of blaming the victim. Web site after web site promoting the false claims of woo practitioners attack modern science as bad or evil, demonizing science. It’s Luddite thinking and anti-intellectual thinking. As I wrote in the post, it’s a rot.

    “Their tone shouldn’t discredit their work”. I would think that a writer like you would appreciate the importance of tone establishing and maintaining a writer’s authority.”
    I appreciate tone as attitude and context, but it exists outside of evidence. I can yell that the sky is green all day but it don’t make it so. So the SBM people are snarky? Their position is well founded and their reasoning sound. My tone is confrontational and aggressive and we’re having a discussion about my logic.

    “Why are the sciencebasedmedicine freaks more expert in their fields than the authors of the published papers they are criticizing? Shouldn’t they be sending their criticisms to the journal editors rather than ranting on their blog?”
    Read the literature. The papers themselves show minimal effect. But the media articles that are derived from these articles skew or misinterpret the findings. Part of this is the gutting of the fourth estate – journalists used to have areas of specificity where they had deep knowledge of a field. That’s not the case anymore. Large media outlets consolidate or pool their reporters man of whom don’t have scientific backgrounds. This is why the blogosphere has broken open wide – if there’s no such thing as good journalism, then anyone can be a journalist regardless of ability. It’s a breath of fresh air when a large media outlet gets it right – take Time Magazine’s cover about vaccines and autism for example. To circle back to your point, being a doctor doesn’t automatically mean all of their positions are right or their conclusions sound. I don’t want to make an argument from authority. But they take the time to go through the things they disagree with and point out where and how others got it wrong (or right). It’s transparent. They show their work. That’s rare, especially in the blogosphere. And yes, they also write in to the journals and engage in the community besides blogging.

    “…But Max and the sciencebasedmedicine guys are making one of the most basic errors in interpreting scientific results. They are accepting the null hypothesis….Eventually, when the amount of studies reaches some critical point where everyone can agree that no amount of further study is likely to find an effect, we can essentially accept the null hypothesis. But we are nowhere near there with acupuncture.”
    Really, Craig? By their claim they’ve had 40 fucking centuries they’ve had to get it right and the best they can do is guess. You’d think that a simple testing protocol would reveal that there is a method and a replicable function but it hasn’t. So more tests and more tests and more tests. When is that critical point? I think we passed it a long time ago. Some think we haven’t. Who should decide? Right now we’re having the arguments about what gets covered and what doesn’t by medical insurance. Eventually as part of a national health care system I’m going to be asked to pay for other’s treatments. I’m willing to pay for things I don’t agree with or treatment of illness as a result of lifestyle choices that impact health – to a point – but I will not allow magic modalities or treatments that are nothing more than placebo to be called medicine. It’s the thin edge of the wedge.

    “…But that’s a long way from proving that acupuncture is a scam.”
    Selling something as a treatment that has no better efficacy than placebo to people in chronic pain is damn near criminal behavior to me. No one should suffer, but to be bilked and lied to when there isn’t clear evidence is compounding insult to injury – literally.

  7. 1. I agree that my assessment of the contributions of western medicine to chronic pain is subjective, and that my restatement of your list of them was snarky and dismissive. (Just like most of Science Based Medicine.)

    2. “I’m pointing out that real doctors are attacked in the press by sCAM practitioners because by dragging enough pseudoscience into real science they lower the bar for real treatment. ” That doesn’t sound like an attack to me, but whatever.

    3. “40 fucking centuries,” really? Acupuncture was mostly ignored by western medicine until at least the 1970s. You can’t exactly start the clock on experimental results until some experiments are performed.

    4. You cannot accept the null hypothesis in science. It is against the rules. I need to find some good source to help explain this to you.

    “You’d think that a simple testing protocol would reveal that there is a method and a replicable function but it hasn’t. ” I wouldn’t think that. I know how difficult an experimental protocol this is and how long I think it would take to find a significant result from anything subtle on chronic pain.

    “So more tests and more tests and more tests. When is that critical point? I think we passed it a long time ago. Some think we haven’t. Who should decide? ” No one decides. That’s how it works. Eventually, the pile of evidence becomes big enough that the people denying acupuncture are considered the crazies rather than the people promoting it. Or not.

    5. You also misunderstand the placebo effect. Saying something is no better than placebo means neither that it is the same as no treatment or that its effect is based purely on being fooled into thinking that the treatment is going to be helped.

    6. I think there is merit to your argument about not paying for acupuncture out of our national health care budget. But I don’t think we should block the NIH from funding research on CAM or kick the scientists studying them out of public universities, either. And I also don’t think it’s that big of an expense compared with the money we’re going to spend on well established treatments for the ailments of cigarette smokers, people who eat poorly, and people who aren’t physically active.

  8. Dear Max,

    I love you even when you are wrong.

    Love,

    Craig

  9. My feelings exactly, Craig.
    xo

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