I was surprised when I saw this news item from Georgetown,
Acupuncture Impacts Same Biologic Pathways in Rats that Pain Drugs Target
and the coverage of it at The Guardian,Rats help scientists closer to solving the mystery of acupuncture.
But thanks to Science Based Medicine it became clear:
Basically, quackademic medicine is a phenomenon that has taken
hold over the last two decades in medical academia in which
once ostensibly science-based medical schools and academic
medical centers embrace quackery. This embrace was once called
"complementary and alternative medicine" (CAM) but among quackademics
the preferred term is now "integrative medicine." Of course, when
looked at objectively, integrative medicine is far more a brand
than a specialty. Specifically, it's a combination of rebranding
some science-based modalities, such as nutrition and exercise, as
somehow being "alternative" or "integrative" with the integration of
outright quackery, such as reiki and "energy healing," acupuncture,
and naturopathy, into conventional medicine.
...
Having received a ($1.7 million) grant from the then-National Center
for Complementary and Alternative Medicine (NCCAM), renamed in December
the National Center for Complementary and Integrative Health (NCCIH),
to integrate CAM into its core curriculum, Georgetown proceeded to do
just that.
The kindest description of the conclusions of this study is that it shows that running electrical current through the leg, as opposed to running current through the skin of the back, might decrease stress by decreasing the effect of stress hormones. It does not show that acupuncture works. A more realistic description of these results is that they don't show much of anything that is scientifically interesting. One even wonders if, for instance, there is a simpler explanation, namely that having a needle stuck in the leg and having current run through it hurts less than having a needle stuck in the back and having current run through it. There's no way of knowing because we can't ask the rat. Alternatively, I also note that St36 is rather close to the sciatic nerve, whereas the acupuncture point on the flank used for the sham-EA control is nowhere near a major nerve.
Basically, this is a poorly done study with small numbers that doesn't even test acupuncture but electricity. If this is the "evidence" for acupuncture that Georgetown touts, it's thin gruel indeed. Yet it was published in a respectable journal, Endocrinology. Clearly, Endocrinology needs a better class of peer reviewers, as peer review utterly failed in this case.
Do read the entire SMB post Bastions of quackademic medicine: Georgetown University as it contains many more details and is entertainingly written.
There is no cure for cystic fibrosis. There is no cure for cancer. There is no cure for diabetes. There is no cure for HIV. There is no cure for Tay-sachs or Huntington's disease or ALS.
And yet, scientists, the media, and the foundations that fund research consistently promise patients and their families that cures for very serious, lifelong diseases are imminent, or at least "around the corner." For cystic fibrosis, that cure has been pitched as being gene therapy, in which a faulty gene is replaced with a functioning one.
Competition and conflicts of interest distort too many medical findings -- John P. A. Ioannidis | May 17, 2011
False positives and exaggerated results in peer-reviewed scientific studies have reached epidemic proportions in recent years. The problem is rampant in economics, the social sciences and even the natural sciences, but it is particularly egregious in biomedicine.
"A lot of what is published is incorrect."
The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness.
Can bad scientific practices be fixed? Part of the problem is that no-one is incentivised to be right. Instead, scientists are incentivised to be productive and innovative.
An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?
The researchers called it "low-value care." But, really, it was no-value care. They studied how often people received one of twenty-six tests or treatments that scientific and professional organizations have consistently determined to have no benefit or to be outright harmful. Their list included doing an EEG for an uncomplicated headache (EEGs are for diagnosing seizure disorders, not headaches), or doing a CT or MRI scan for low-back pain in patients without any signs of a neurological problem (studies consistently show that scanning such patients adds nothing except cost), or putting a coronary-artery stent in patients with stable cardiac disease (the likelihood of a heart attack or death after five years is unaffected by the stent). In just a single year, the researchers reported, twenty-five to forty-two per cent of Medicare patients received at least one of the twenty-six useless tests and treatments.
Doctors generally know more about the value of a given medical treatment than patients, who have little ability to determine the quality of the advice they are getting. Doctors, therefore, are in a powerful position. We can recommend care of little or no value because it enhances our incomes, because it's our habit, or because we genuinely but incorrectly believe in it, and patients will tend to follow our recommendations.
The United States is a country of three hundred million people who annually undergo around fifteen million nuclear medicine scans, a hundred million CT and MRI scans, and almost ten billion laboratory tests. Often, these are fishing expeditions, and since no one is perfectly normal you tend to find a lot of fish. If you look closely and often enough, almost everyone will have a little nodule that can't be completely explained, a lab result that is a bit off, a heart tracing that doesn't look quite right.
Excessive testing is a problem for a number of reasons. For one thing, some diagnostic studies are harmful in themselves--we're doing so many CT scans and other forms of imaging that rely on radiation that they are believed to be increasing the population's cancer rates. These direct risks are often greater than we account for.
Overtesting has also created a new, unanticipated problem: overdiagnosis.
...
For instance, cancer screening with mammography, ultrasound, and blood
testing has dramatically increased the detection of breast, thyroid,
and prostate cancer during the past quarter century. We're treating
hundreds of thousands more people each year for these diseases than
we ever have. Yet only a tiny reduction in death, if any, has resulted.
Cancer screening is a balance to ensure the people who will benefit most get checked while not over-testing. After all, there are potential harms including false alarms that spark unneeded extra testing, and sometimes detection of tumors too small and slow-growing to be life-threatening.
Colonoscopies, which allow doctors to see precancerous growths in the colon, get the most attention. But the ACP advised people ages 50 to 74 to choose from equally good screening choices: a stool test every year; a colonoscopy every 10 years; a sigmoidoscopy, which views the lower colon, every five years; or a combination of a stool test every three years and a sigmoidoscopy every five years.