Skeptical Raptor's Blog hunting pseudoscience in the internet jungle

Treating depression with acupuncture-evidence is lacking


hellraiser-pinheadLet’s start out with a basic point–acupuncture does not work. For anything in medicine. And because there is a small, but significant, risk associated with the “procedure,” the risk to benefit ratio is huge (if not infinity, since there is no benefit). 

Just in case you don’t believe me, Steven Novella, MD, of the Science Based Medicine blog, clarifies why acupuncture does not work:

Clinical research can never prove that an intervention has an effect size of zero. Rather, clinical research assumes the null hypothesis, that the treatment does not work, and the burden of proof lies with demonstrating adequate evidence to reject the null hypothesis. So, when being technical, researchers will conclude that a negative study “fails to reject the null hypothesis.”

Further, negative studies do not demonstrate an effect size of zero, but rather that any possible effect is likely to be smaller than the power of existing research to detect. The greater the number and power of such studies, however, the closer this remaining possible effect size gets to zero. At some point the remaining possible effect becomes clinically insignificant.

In other words, clinical research may not be able to detect the difference between zero effect and a tiny effect, but at some point it becomes irrelevant.

This is basic scientific reasoning. We cannot prove that acupuncture does not work, but if the effect is so small, that it is clinically irrelevant, in effect, it is a zero effect.

…after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant.

In layman’s terms, acupuncture does not work – for anything.

This has profound clinical, ethical, scientific, and practical implications. In my opinion humanity should not waste another penny, another moment, another patient – any further resources on this dead end. We should consider this a lesson learned, cut our losses, and move on.

I suspect, however, human nature being what it is, that this will not happen anytime soon.

David Colquhoun and Novella, in an a published article, reviewed much of what passes for “science” in acupuncture clinical research. And he found no evidence supporting the clinical value of acupuncture:

Large multicenter clinical trials conducted in Germany (here, here, here and here) and the United States consistently revealed that verum (or true) acupuncture and sham acupuncture treatments are no different in decreasing pain levels across multiple chronic pain disorders: migraine, tension headache, low back pain, and osteoarthritis of the knee.

If, indeed, sham acupuncture is no different from real acupuncture, the apparent improvement that may be seen after acupuncture is merely a placebo effect. Furthermore, it shows that the idea of meridians is purely imaginary. All that remains to be discussed is whether or not the placebo effect is big enough to be useful, and whether it is ethical to prescribe placebos.

So given that there is no evidence that acupuncture does anything, isn’t it time to give up? Apparently not. PLOS One, the peer-reviewed open-access journal (that has been described as being a higher quality than other open-access journals) published an article that indicates that acupuncture may be useful in treating depression. This would be all well and good if it were not for the absolutely poor quality of the research in the paper.

  • Acupuncture lacks a credible scientific explanation for any of its effects. No different than homeopathy, it relies upon magic and pseudoscience to explain how it might work. This article does not provide a credible explanation of effects, which must be a requirement for any observation.
  • The study lacked a control group, usually a sham treatment (a non-acupuncture treatment that mimics or fakes the acupuncture, but the patient perceives the procedure as being similar). We have no clue if the idea of having treatment for depression has some effect on depression (rather than acupuncture itself having any effect).
  • The practitioners were obviously not blinded to the outcome of of depression, because there was not a non-depressed group to randomize. This is a ridiculous opening for all kinds of problems including Confirmation Bias. In fact, I’m utterly shocked that PLOS One published this article without demanding appropriate control groups.
  • Measuring depression can be greatly influenced by observer bias, in this case by the the clinical practitioners. There are no defined, objective clinical tests for depression. There is no blood test or other methodology to objectively measure depression.
  • Systematic reviews have shown that there is no clinical evidence for treating depression in over 2800 study participants, concluding that “We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.” This current study only include 200 patients in the acupuncture group. This one study, even if it were well designed, would not refute the systematic review.
  • And one more thing. The effect, if there was an effect, was temporary. As the study went on, there were no noticeable differences between the acupuncture group, the counseling alone group, and the “usual care” group at 9 and 12 months. This is what you’d expect from a placebo.

This is a ridiculously poorly designed study with laughable results. Yet, all you need to do is Google “acupuncture depression”, and you will get a large list of  websites that cite this article. Of course, the loon at Natural News claims that acupuncture is proven to treat depression. Well, if you base your medical treatment on the rantings of the worst science site on the internet, you probably won’t be reading my article.

Let’s go back to Colquhoun and Novella’s article about acupuncture:

The best controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work. Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research. The most parsimonious conclusion is that with acupuncture there is no signal, only noise.

Here’s what Edzard Ernst, one of the world’s leading complementary and alternative medicine skeptics, wrote in a systematic review of systematic reviews (required because some systematic reviews are just poorly done):

…the effectiveness of acupuncture as a treatment of depression remains unproven and the authors’ findings are consistent with acupuncture effects in depression being indistinguishable from placebo effects.

Given the utter lack of evidence supporting the effectiveness of acupuncture for anything, including depression, there is no reason to think that this study has provided us with any evidence to change the scientific consensus about this pseudoscience. Acupuncture does not provide a positive outcome in treating depression, beyond a placebo effect. The standard of care, counseling and proper medications, for depression has not been superseded by this study.

Key citation:

 

Comments (10)

Please add your comments to my article

Powered by WordPress 3.8.3