Amazingly, this article is still repeatedly cited as an authorative source on the matter, so I figured sooner or later I'd have to post this online.
I won’t lie, I’m negatively biased against quackwatch. The most frustrating thing about the site is that I actually agree with some of their positions (that some alternative health practices are quackery), while also completely disagreeing with others, and even more so the style of attack employed. I pulled up this article from their website, and thought it was so rife with flaws that I should comment on it. Chinese medicine is a field I feel I hold a degree of expertise on, so I can refute the factual arguments here instead of just the logical fallacies employed. I have grown up around some of the top field in this field, so most of the information here is second nature to me, and I have a great deal of hands on experience with the matter.The article was acquired on October 26, 2007 follows. http://www.quackwatch.com/01QuackeryRelatedTopics/acu.html All my comments henceforth are in italics. Pretend they did not exist for reading the original article.
Be Wary of Acupuncture, Qigong, and "Chinese Medicine"
Stephen Barrett, M.D.
"Chinese medicine," often called "Oriental medicine" or "traditional Chinese medicine (TCM)," encompasses a vast array of folk medical practices based on mysticism. It holds that the body's vital energy (chi or qi) circulates through channels, called meridians, that have branches connected to bodily organs and functions. Illness is attributed to imbalance or interruption of chi.. Ancient practices such as acupuncture, Qigong, and the use of various herbs are claimed to restore balance.Stephen Barrett, M.D.
This is a fairly accurate definition, all though a few core concepts are missing. The three branches listed at the start are completely different however.
Traditional acupuncture, as now practiced, involves the insertion of stainless steel needles into various body areas. A low-frequency current may be applied to the needles to produce greater stimulation. Other procedures used separately or together with acupuncture include: moxibustion (burning of floss or herbs applied to the skin); injection of sterile water, procaine, morphine, vitamins, or homeopathic solutions through the inserted needles; applications of laser beams (laserpuncture); placement of needles in the external ear (auriculotherapy); and acupressure (use of manual pressure). Treatment is applied to "acupuncture points," which are said to be located throughout the body. Originally there were 365 such points, corresponding to the days of the year, but the number identified by proponents during the past 2,000 years has increased gradually to about 2,000 [1]. Some practitioners place needles at or near the site of disease, whereas others select points on the basis of symptoms. In traditional acupuncture, a combination of points is usually used.
Now some mistakes are made. Injections are very rare, and not part of traditional acupuncture practice. The laser method was invented in France for Europeans who were squeamish about having needles injected. Acupressure is a different field. There are 360 commonly traditionally used points, and another 360 occasionally used points. The 2000 figure is wrong and not part of the traditional methods. The comment about needle placing intends to imply there is not consistent framework over how needles are placed, a falsehood. Simply put, two factors are involved. First some problems merit a direct attack, others merit involving the entire system. Secondly, there are two methods of acupuncture, the simpler more commonly taught method focuses on directly targeting the problem, while the harder and more advanced school focuses upon the indirect approach.
Qigong is also claimed to influence the flow of "vital energy." Internal Qigong involves deep breathing, concentration, and relaxation techniques used by individuals for themselves. External Qigong is performed by "Qigong masters" who claim to cure a wide variety of diseases with energy released from their fingertips. However, scientific investigators of Qigong masters in China have found no evidence of paranormal powers and some evidence of deception. They found, for example, that a patient lying on a table about eight feet from a Qigong master moved rhythmically or thrashed about as the master moved his hands. But when she was placed so that she could no longer see him, her movements were unrelated to his [2]. Falun gong, which China recently banned, is a Qigong varient claimed to be "a powerful mechanism for healing, stress relief and health improvements."
External Qigong is commonly used in China, but accurately measuring it with our method of science is difficult, although I have seen many case studies which prove an effect. The Qigong master normally seeks to correct the flow of energy inside a person much like a needle, not as the description implies inject it. Paranormal powers is an emotional trigger word used to give negative implications to anyone who can heal injuries in this fashion. The Falun gong was a cult banned by China for being a subversive cult that has tried to challenge the government. It was not banned for practicing “quackery.” Once again, while having no relevance whatsoever to Qigong’s validity, it is used to smear the subject.
Most acupuncturists espouse the traditional Chinese view of health and disease and consider acupuncture, herbal medicine, and related practices to be valid approaches to the full gamut of disease. Others reject the traditional approach and merely claim that acupuncture offers a simple way to achieve pain relief. The diagnostic process used by TCM practitioners may include questioning (medical history, lifestyle), observations (skin, tongue, color), listening (breathing sounds), and pulse-taking. Six pulse aspects said to correlate with body organs or functions are checked on each wrist to determine which meridians are "deficient" in chi. (Medical science recognizes only one pulse, corresponding to the heartbeat, which can be felt in the wrist, neck, feet, and various other places.) Some acupuncturists state that the electrical properties of the body may become imbalanced weeks or even months before symptoms occur. These practitioners claim that acupuncture can be used to treat conditions when the patient just "doesn't feel right," even though no disease is apparent.
I disagree with the first assertion. Many acupuncturists have a penchant for preferring their methods over allopathy, but one requirement of training is to know when the problem out steps your abilities. Acupuncturists do not tell car accident victims to choose needles over the ER room. Within acupuncture, the belief is that unskilled practitioners can only cure pain, while more skilled can do more. There are actually more than 6 pules, but the argument to debunk this claim is absurd. Barrett is attaching a completely separate definition to the concept. A pulse is when the heart beats. Therefore The Chinese believing that pulses can have different characteristics (ie. speed, strength, pressure) is wrong since only one type of pulse can exist. The wrist is used to feel the pulse since it is the easiest place to observe it. I can’t tell if the next statement is a criticism, but if it is, then Barrett is claiming that before the onset of disease, the body stays the same and it is not possible to detect the onset of say a flu. Finally, he cites the logical fallacy of “if something cannot be observed it does not exist.” Many diseases in medicine have been impossible to diagnose, and labeled as psychosomatic until the actual problem was discovered. If you have something like being consistently tired and fatigued, you are assumed to not have a disease. But does that mean in that state you are fine and removing the fatigue is quackery?
TCM (as well as the folk medical practices of various other Asian countries) is a threat to certain animal species. For example, black bears—valued for their gall bladders—have been hunted nearly to extinction in Asia, and poaching of black bears is a growing problem in North America.
This has almost nothing to do with the legitimacy of Chinese medicine, it is just a trivial point brought up as emotional attack to demonize the field. That said, this is a problem, but in the better schools of Chinese Medicine demand for these items is smaller. At the same time however, is China the only country that has devastated the environment and killed off animal populations?
Dubious Claims
The conditions claimed to respond to acupuncture include chronic pain (neck and back pain, migraine headaches), acute injury-related pain (strains, muscle and ligament tears), gastrointestinal problems (indigestion, ulcers, constipation, diarrhea), cardiovascular conditions (high and low blood pressure), genitourinary problems (menstrual irregularity, frigidity, impotence), muscle and nerve conditions (paralysis, deafness), and behavioral problems (overeating, drug dependence, smoking). However, the evidence supporting these claims consists mostly of practitioners' observations and poorly designed studies. A controlled study found that electroacupuncture of the ear was no more effective than placebo stimulation (light touching) against chronic pain [3]. In 1990, three Dutch epidemiologists analyzed 51 controlled studies of acupuncture for chronic pain and concluded that "the quality of even the better studies proved to be mediocre. . . . The efficacy of acupuncture in the treatment of chronic pain remains doubtful." [4] They also examined reports of acupuncture used to treat addictions to cigarettes, heroin, and alcohol, and concluded that claims that acupuncture is effective as a therapy for these conditions are not supported by sound clinical research [5].
The first thing to note about the list presented is that none of them are immediately life threatening conditions. If the acupuncturist is unable to do anything, then they have the opportunity to see a conventional doctor, and at worse wasted their money on a much cheaper treatment plan (although after treatment, most do not require allopathy). Secondly, “well designed” studies by our criteria require large amounts of funding not accessible to the field. China has produced studies showing it’s effectiveness but they have been ignored. Given the nature of the subject it is extremely difficult to test in a double blind manner, and as such consistent positive results for patients should not be trivialized as “consists mostly of practitioners' observations and poorly designed studies.” The choice of studies illustrates a selective bias.
Acupuncture anesthesia is not used for surgery in the Orient to the extent that its proponents suggest. In China physicians screen out patients who appear to be unsuitable. Acupuncture is not used for emergency surgery and often is accompanied by local anesthesia or narcotic medication [6].
Video evidence exists of this working, and the attempt to disprove it is based off of generalizations using faulty data and subjective reasoning. Clearly someone being able to be awake during brain surgery cannot be covered under placebo, so a different logical fallacy must be utilized to discredit the practice here.
How acupuncture may relieve pain is unclear. One theory suggests that pain impulses are blocked from reaching the spinal cord or brain at various "gates" to these areas. Another theory suggests that acupuncture stimulates the body to produce narcotic-like substances called endorphins, which reduce pain. Other theories suggest that the placebo effect, external suggestion (hypnosis), and cultural conditioning are important factors. Melzack and Wall note that pain relief produced by acupuncture can also be produced by many other types of sensory hyperstimulation, such as electricity and heat at acupuncture points and elsewhere in the body. They conclude that "the effectiveness of all of these forms of stimulation indicates that acupuncture is not a magical procedure but only one of many ways to produce analgesia [pain relief] by an intense sensory input." In 1981, the American Medical Association Council on Scientific Affairs noted that pain relief does not occur consistently or reproducibly in most people and does not operate at all in some people [7].
For starters, an admission is made that the process is not understood. That means what follows cannot be construed as objective fact. Numerous examples of acupuncture working have occurred in cases where endorphins cannot be applicable. There is no criteria detailed here for how to evaluate different forms of pain relief being equivalent (this is a very big false assumption underpinning the entire argument). The argument basically could be paraphrased as “if you tickle someone a lot, we believe the over stimulation of senses is sufficient to act as a painkiller. Therefore likewise in acupuncture it is nothing more than sensory stimulation that creates pain relief, and both worthless and trivial.” This argument also ignores acupuncture’s ability to affect other conditions besides pain, and cannot address why only certain points matter. Finally, the last statement says “because the process or results are not identical in every treatment, the entire practice is unscientific and flawed.” Yet, if you give two people the same “scientific” drug dosage they will have different reactions. Bad logic.
In 1995, George A. Ulett, M.D., Ph.D., Clinical Professor of Psychiatry, University of Missouri School of Medicine, stated that "devoid of metaphysical thinking, acupuncture becomes a rather simple technique that can be useful as a non-drug method of pain control." He believes that the traditional Chinese variety is primarily a placebo treatment, but electrical stimulation of about 80 acupuncture points has been proven useful for pain control [8].
This is an example of a common logical fallacy Barrett uses. If someone with a PhD subjectively believes ____ is true, then it can be quoted as truth. If we can’t explain something, then it must be placebo!
The quality of TCM research in China has been extremely poor. A recent analysis of 2,938 reports of clinical trials reported in Chinese medical journals concluded that that no conclusions could be drawn from the vast majority of them. The researchers stated:
This is outdated information, and indicative of selection bias. In my own subjective opinion, I would wager that the attitude being conveyed is equivalent to “since scientific studies and evaluation is our realm of dominion, we have the right to choose to refute any foreign party’s attempt to provide scientific studies.”
In most of the trials, disease was defined and diagnosed according to conventional medicine; trial outcomes were assessed with objective or subjective (or both) methods of conventional medicine, often complemented by traditional Chinese methods. Over 90% of the trials in non-specialist journals evaluated herbal treatments that were mostly proprietary Chinese medicines. . . .
Aren’t most funded medical studies that occur in the United States for proprietary pharmaceuticals? This is mostly since they are the main ones that fund them.
....Although methodological quality has been improving over the years, many problems remain. The method of randomisation was often inappropriately described. Blinding was used in only 15% of trials. Only a few studies had sample sizes of 300 subjects or more. Many trials used as a control another Chinese medicine treatment whose effectiveness had often not been evaluated by randomised controlled trials. Most trials focused on short term or intermediate rather than long term outcomes. Most trials did not report data on compliance and completeness of follow up. Effectiveness was rarely quantitatively expressed and reported. Intention to treat analysis was never mentioned. Over half did not report data on baseline characteristics or on side effects. Many trials were published as short reports. Most trials claimed that the tested treatments were effective, indicating that publication bias may be common; a funnel plot of the 49 trials of acupuncture in the treatment of stroke confirmed selective publication of positive trials in the area, suggesting that acupuncture may not be more effective than the control treatments. [9]
This report is fairly outdated, although at the same time, is treated as currently relevant for Barrett’s condemnation of Chinese Medicine. China did not originally have an academia built up that functioned similarly to the Western Model, and they have been working to learn how to match it. The statement starts off with an acknowledgement that the Chinese are improving, but then ignores the fact this information is outdated (and hence inaccurate if improvement was occurring). Many of the requirements being asked for are difficult and expensive to do (large groups, long term outcomes, etc). Given the nature of Chinese medicine and the “systemic/holistic” method of thinking, so in some categories quantitative measures were not procurable. These studies would not stand up to examination at Harvard, so that means Chinese Medicine, and the Chinese scientists attempted to study the matter with resources and limited experience are not qualified to do so, and Chinese Medicine is worthless and unscientific (which it would also be if no trials were conducted, the alternative being advocated).
Two scientists at the University of Heidelberg have developed a "fake needle" that may enable acupuncture researchers to perform better-designed controlled studies. The device is a needle with a blunt tip that moves freely within a copper handle. When the tip touches the skin, the patient feels a sensation similar to that of an acupuncture needle. At the same time, the visible part of the needle moves inside the handle so it appears to shorten as though penetrating the skin. When the device was tested on volunteers, none suspected that it had not penetrated the skin [10].
I really do not follow how this one can be true. When an acupuncture needle is inserted into the body, you should be able to feel it. Even if you cannot, once the needle gets in, it will begin manipulating your energetic system. If there are any blockages in your system, the experience is quite painful (the closest sensation I can think of is a liquid anesthesia being forcefully injected into you, and the feeling you have of something unpleasant pushing through you, before the numbing sets in). I could assemble a group of 20 people for a study within a day, and I would be surprised if one could not tell.
In 2004, a University of Heidelberg team proved the worth of their "sham acupuncture" technique in a study of postoperative nausea and vomiting (PONV) in women who underwent breast or gynecologic surgery. The study involved 220 women who received either acupuncture or the sham procedure at the acupuncture point "Pericardium 6" on the inside of the forearm. No significant difference in PONV or antivomiting medication use was found between the two groups or between the people who received treatment before anesthesia was induced and those who received it while anesthetized [11]. A subgroup analysis found that vomiting was "significantly reduced" among the acupuncture patients, but the authors correctly noted that this finding might be due to studying multiple outcomes. (As the number of different outcome measures increases, so do the odds that a "statistically significant" finding will be spurious.) This study is important because PONV reduction is one of the few alleged benefits of acupuncture supported by reports in scientific journals. However, the other positive studies were not as tightly controlled..
How do you know the acupuncture was properly done? Don’t forget that if any results come up which question your hypothesis, they can be labeled as wrong or the result of a fluke! I’m pretty sure acupuncture is used for a bit more than PNOV. You’ve got to be careful with these sweeping generalizations.Overall, I believe the argument made here is, “since you are unscientific by our standards, you are wrong.” That’s not a great argument to make, and it also neglects the fact that they don’t have to ability to match our standards (although they are trying to). It sounds a bit whiny, bit I really think Barrett needs to be nicer here.
Risks Exist
Improperly performed acupuncture can cause fainting, local hematoma (due to bleeding from a punctured blood vessel), pneumothorax (punctured lung), convulsions, local infections, hepatitis B (from unsterile needles), bacterial endocarditis, contact dermatitis, and nerve damage. The herbs used by acupuncture practitioners are not regulated for safety, potency, or effectiveness. There is also risk that an acupuncturist whose approach to diagnosis is not based on scientific concepts will fail to diagnose a dangerous condition.
Incidences of danger like the ones described here are extremely rare. One of the main points of acupuncture training is so that none of the described things will happen. Unless the acupuncture physician is using rather bold methods of treatment, most needles are applied near the surface of the skin, and never get the option to be close to critical spots (ie puncturing the lungs). Compare sticking a few needles in someone to carrying out surgery. One practice is wholly more invasive than the other, and much more likely to cause damage. If someone sees an acupuncturist, they are often much more likely to pick up on precursors for a disease than an allopath (it’s that darned holistic thinking). In addition many people who see acupuncturists because they don’t feel great, would not choose to see a doctor instead if they could not do the former (perhaps since a doctors visit is unpleasant, expensive, and not very good at addressing these sorts of “psychosomatic problems.”) All in all, the argument seems like nothing more than a lament over acupuncturists stealing their business and patients and money.
The adverse effects of acupuncture are probably related to the nature of the practitioner's training. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 other cases with complications. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results [12]. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports (including 16 forgotten needles and 13 cases of transient low blood pressure) associated with 55,591 acupuncture treatments. No serious complications were reported. The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained [13].
(Not counting anything besides fatalities, and excluding fatalities for risks deemed necessary) a JAMA study concluded that mistakes by doctors have caused 225,000 unnecessary deaths in the US each year. Compared to that, the field of acupuncture sure seems awful, since inexperienced practitioners sometimes make mistakes. No system of medicine exists which is perfect, but a perception has been created that the mighty allopathy is objective and infallible. This argument seems to based around appealing to that image.
Moe recently, members of the British Acupuncture Council who participated in two prospective studies have reported low complication rates and no serious complications among patients who underwent a total of more than 66,000 treatments 14,15]. An accompany editorial suggests that in competent hands, the likelihood of complcations is small [16]. Since outcome data are not available, the studies cannot compare the balance of risks vs benefit. Nor do the studies take into account the likelihood of misdiagnosis (and failure to seek appropriate medical care) by practitioners who use traditional Chinese methods.
The study concluded acupuncture is relatively harmless. So, how can that be rejected to support the anti Chinese medicine standpoint? Outcome data is not available, so we have a way to contest the study not being fully complete, and we can’t compare risks verses benefits. Wait, wait, wait. Risks verses benefits is a very common idea in allopathy because some of the cures used are dangerous and invasive, so the risks have to be considered to outweigh the benefits to be justified in using them, and a storage site of statistics to promote certain cures is essential (the absurdity of this method is apparent when you have to deal with cancer). But, the study just established Chinese medicine has no risk! So there is no need to way risks verses benefits to decide upon a cure. Come on!
Questionable Standards
In 1971, an acupuncture boom occurred in the United States because of stories about visits to China by various American dignitaries. Entrepreneurs, both medical and nonmedical, began using flamboyant advertising techniques to promote clinics, seminars, demonstrations, books, correspondence courses, and do-it-yourself kits. Today some states restrict the practice of acupuncture to physicians or others operating under their direct supervision. In about 20 states, people who lack medical training can perform acupuncture without medical supervision. The FDA now classifies acupuncture needles as Class II medical devices and requires labeling for one-time use by practitioners who are legally authorized to use them [17]. Acupuncture is not covered under Medicare. The March 1998 issue of the Journal of the American Chiropractic Association carried a five-part cover story encouraging chiropractors to get acupuncture training, which, according to one contributor, would enable them to broaden the scope of their practice [18].
I agree with everything up to the 17 and have no qualms with it. People who practice it with almost no training are a problem, and many people are gullible enough to partake in it. After that however, the logical fallacies remerge. Medicare doesn’t pay for acupuncture, therefore acupuncture is bad. What about the complaints over other insurance programs covering acupuncture? Chiropractors think acupuncture is good and Barrett’s mission is to attack the profession. He’s arguing guilt by association here even though Chiropractors (who are “bad” because Barrett has asserted they are) did not create the subject, they just thought it was cool.
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) has set voluntary certification standards and certified several thousand practitioners. By November 1998, 32 states had licensing laws, with 29 of them using NCCAOM examination as all or part of their educational, training, or examination requirement, and three with addditional eligibility criteria. The credentials used by acupuncturists include C.A. (certified acupuncturist), Lic. Ac. (licensed acupuncturist), M.A. (master acupuncturist), Dip. Ac. (diplomate of acupuncture), and O.M.D. (doctor of Oriental medicine). Some of these have legal significance, but they do not signify that the holder is competent to make adequate diagnoses or render appropriate treatment.In 1990, the U.S. Secretary of Education recognized what is now called the Accreditation Commission for Acupuncture and Oriental Medicine (ACAOM) as an accrediting agency. However, such recognition is not based on the scientific validity of what is taught but upon other criteria [19].
As with the previous passage, I agree with most of this part. However, this line is just spiteful and unfounded “but they do not signify that the holder is competent to make adequate diagnoses or render appropriate treatment.” Imagine going to medical school, training really hard in the material, and then being told you are not competent because you practice something someone else (who is all knowing) does not approve of. The final statement is another subjective statement which might as well say “science doesn’t like you, therefore you are worthless.”
Ulett has noted:Certification of acupuncturists is a sham. While a few of those so accredited are naive physicians, most are nonmedical persons who only play at being doctor and use this certification as an umbrella for a host of unproven New Age hokum treatments. Unfortunately, a few HMOs, hospitals, and even medical schools are succumbing to the bait and exposing patients to such bogus treatments when they need real medical care.
Someone wrote a (once again unsubstantiated) tirade upon the ills of acupuncture and it thus is accepted as fact since it can be used to discredit the field. The logic in the statement makes sure to throw in a few good ad hominems and isn’t even very consistent. “Only someone who studies our medicine is qualified to be a physician, so acupuncturists are bad doctors,” but uh, the people match that criteria and do it anyways, so they are uh…”naïve.”
The National Council Against Health Fraud has concluded:
The NCAHF is an organization Barrett is part of, the website is even laid out in the same way as quackwatch. I was originally planning to discuss their report, but felt this one would be more productive. One classic tactic used in these circles is to make another organization, give it an impressive unbiased title, expout your viewpoints on the matter, and then cite the matter as truth.
Most the report was extremely subjective facts Barrett chose to quote as the truth, and the following claims below were not substanciated. In the original report it even said “The NCAHF believes that….” As for the specific points, here was why I contested them.
*Acupuncture is an unproven modality of treatment. This statement most appears to be another slandering statement. The keyword is “unproven,” which is another way of saying “we don’t understand.” Or differently put “because we do not understand how this works, it is bad.
*Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge. Once again, the first half of the description is meaningless emotional attack phrases. I gave the report some tolerance on this matter since it was 17 years old, at which point I cannot be aware of the available literature, but repeating it in a more modern update is irresponsible. Really, he’s saying nothing in Chinese medicine overlaps with western medicine. Nothing at all.
*Research during the past 20 years has not demonstrated that acupuncture is effective against any disease. Only if you selectively pick studies. This is another blatant distortion of the available data and a subjective slandering generalization.
*Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms. Probably is another way of saying “we don’t know.”
*The use of acupuncture should be restricted to appropriate research settings. This one is about as arrogant as you can get. Something which has been practiced for thousands of years should only be permitted to exist under the yolk of Barret’s science? While you’re at it why don’t you go after the Native Americans for all the unscientific stuff they’ve been doing for just as long.
*Insurance companies should not be required by law to cover acupuncture treatment. I felt to convey Barrett’s traditional intention, the meaning should have been reversed (required not to cover acupuncture). Insurance companies to some degree should cater to their consumers, but I am not a legal expert, so I can’t really comment on this one.
*Licensure of lay acupuncturists should be phased out. This is yet another arbitrary statement asserted as truth. Having read what they consider to be “lay acupuncturists” I cannot agree with the stance, but essentially this statement is mostly another assertion with no more foundation than cats being better pets than dogs. Put differently it's also a "gee oh really?" statement. A panel which is blatantly biased against accupuncture and put into place to attack it concludes it should stop being practiced. Since you might not know the sky is blue, we should tell you that too.
*Consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest. But you (NCAHF) have a commercial interest in conventional medicine! Most doctors have commercial interests, and this statement makes the assumption only an MD is qualified to make any decisions about health. It's a very common practice for pharacutical companies to send representatives to doctors to try and get them to perscribe their medication, along with "educational gifts" along the way such as free trips to hawaii. I think that's a far larger common place conflict of interest.
The NIH Debacle
note the term debacle
In 1997, a Consensus Development Conference sponsored by the National Institutes of Health and several other agencies concluded that "there is sufficient evidence . . . of acupuncture's value to expand its use into conventional medicine and to encourage further studies of its physiology and clinical value." [21] The panelists also suggested that the federal government and insurance companies expand coverage of acupuncture so more people can have access to it. These conclusions were not based on research done after NCAHF's position paper was published. Rather, they reflected the bias of the panelists who were selected by a planning committee dominated by acupuncture proponents [22]. NCAHF board chairman Wallace Sampson, M.D., has described the conference "a consensus of proponents, not a consensus of valid scientific opinion."
What amazes me about Barrett’s argument style is how quickly he uses the holes of his arguments to attack others. “The panel might have been biased, therefore its subjective opinion was worthless,” because someone who disagreed with it said it was Come on! The medical field is so stacked against acupuncture at this point that getting a panel to agree upon its value signifies there has to be fairly strong evidence. Wallace Sampson is someone who happens to also be part of a group dedicated to opposing alternative medicine. Even if you assume he wasn’t distorting the truth, to anyone who lives for that purpose, any official divergence from that position (government panels are known for being amongst the least biased), cannot be comprehended. It’s such a shame a paper made by a group opposed to the practice was not considered in the briefing. If you have the time to read a book called Trust Us, We’re Experts, it details that a very common tactic used by the PR industry to influence government decisions consists of hiring lots of independent think tanks to publish papers supporting the position. But, these arguments aren’t really about getting to the truth. It’s just a question of using whatever angle is available to disprove alternative medicine.
Although the report described some serious problems, it failed to place them into proper perspective. The panel acknowledged that "the vast majority of papers studying acupuncture consist of case reports, case series, or intervention studies with designs inadequate to assess efficacy" and that "relatively few" high-quality controlled trials have been published about acupuncture's effects. But it reported that "the World Health Organization has listed more than 40 [conditions] for which [acupuncture] may be indicated." This sentence should have been followed by a statement that the list was not valid.
Proper perspective (also known as “does not agree with mine”) is about as subjective as you can get. If a great deal of evidence exists to support that a practice works, but double blind trials are somewhat lacking from that pool, then it is worthless and it is not valid for treating anything, even if other scientific organizations have cited the efficacy. Really what’s the basis for the “should” in the last line.
Far more serious, although the consensus report touched on Chinese acupuncture theory, it failed to point out the danger and economic waste involved in going to practitioners who can't make appropriate diagnoses. The report noted:
This is a very bad double standard. Conventional doctors do every single complaint cited here to a much higher degree, and as previously explained; many of the objections are not very well justified.
*The general theory of acupuncture is based on the premise that there are patterns of energy flow (Qi) through the body that are essential for health. Disruptions of this flow are believed to be responsible for disease. The acupuncturist can correct imbalances of flow at identifiable points close to the skin.
*Acupuncture focuses on a holistic, energy-based approach to the patient rather than a disease-oriented diagnostic and treatment model.
*Despite considerable efforts to understand the anatomy and physiology of the "acupuncture points," the definition and characterization of these points remains controversial. Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.
Although I think it could be phrased better, I agree with these findings.
Simply stated, this means that if you go to a practitioner who practices traditional Chinese medicine, you are unlikely to be properly diagnosed.
Incorrect paraphrasing is another logical fallacy. This report is actually saying that we do not fully understand how Chinese medicine works, and it has a different framework for evaluating the body that allopathy. Since this is basically a positive endorsement of acupuncture, Barrett’s only option is to pick a different grounds to attack the matter on. In this case he chose to declare this translates to you getting what he deems an incorrect diagnostic, while it actually means you will not get a traditional allopathic diagnostic.
Diagnostic Studies
In 1998, following his lecture at a local college, an experienced TCM practitioner diagnosed me by taking my pulse and looking at my tongue. He stated that my pulse showed signs of "stress" and that my tongue indicated I was suffering from "congestion of the blood." A few minutes later, he examined a woman and told her that her pulse showed premature ventricular contractions (a disturbance of the heart's rhythm that could be harmless or significant, depending on whether the individual has underlying heart disease). He suggested that both of us undergo treatment with acupuncture and herbs—which would have cost about $90 per visit. I took the woman's pulse and found that it was completely normal. I believe that the majority of nonmedical acupuncturists rely on improper diagnostic procedures. The NIH consensus panel should have emphasized the seriousness of this problem.
Barrett is making a very serious error here, commenting on a diagnostic procedure he does not understand the criteria for. Additionally, the scientific community abhors single anecdotal studies done without proper experimental settings, or research published without peer review, both of which criteria this example fulfills!
This testimony leaves me with a few questions. Was Barrett ever trained in palpation? Does he even have the ability to feel anything within the body beyond extremely obvious traits? If an allopath improperly advocates additional testing or consultation to you (which happens very frequently, and if you look into the history of quackwatch, it’s formation stemmed from a government decision that wasteful overspending in medicine had to be cracked down upon. However, instead they decided to focus on alternative medicine via methods such as quackwatch) how much does it cost? $90.00 is chump change. In good practice, Barrett concludes this with a few more appeals to authority to vindicate his point. These points really need to be held up to a higher standard.
A study published in 2001 illustrates the absurdity of TCM practices. A 40-year-old woman with chronic back pain who visited seven acupuncturists during a two-week period was diagnosed with "Qi stagnation" by 6 of them, "blood stagnation" by 5 , "kidney Qi deficiency" by 2, "yin deficiency" by 1, and "liver Qi deficiency" by 1. The proposed treatments varied even more. Among the six who recorded their recommendations, the practitioners planned to use between 7 and 26 needles inserted into 4 to 16 specific "acupuncture points" in the back, leg, hand, and foot. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. [23] The study appears to have been designed to make the results as consistent as possible. All of the acupuncturists had been trained at a school of traditional Chinese medicine (TCM). Six other volunteers were excluded because they "used highly atypical practices," and three were excluded because they had been in practice for less than three years. Whereas science-based methods are thoroughly studied to ensure that they are reliable, this appears to be the first published study that examines the consistency of TCM diagnosis or treatment. I would expect larger studies to show that TCM diagnoses are meaningless and have little or nothing to do with the patient's health status. The study's authors state that the diagnostic findings showed "considerable consistency" because nearly all of the practitioners found Qi or blood stagnation. However, the most likely explanation is that these are diagnosed in nearly everyone. It would be fascinating to see what would happen if a healthy person was examined by multiple acupuncturists.
This is a harder point to argue without knowing about the specific case or the acupuncturists involved. The model TCM people are taught is to evaluate the problem with their senses, and then try to think of an approach or plan which will correct the problem. This means that similarities will exist in what they discover and differences as well. Strange as it might seem, there are multiple ways to understand a problem (since so many systems are linked together), but from the perspective of someone not taught to understand the practice, this is unfathomable. Chinese medicine was practiced in China for thousands of years and adopted by the West on the basis of it’s merits, not in its ability to perfectly replicate results. Each human being is different, and things that happen will change between them. Barrett is essentially using some (questionable and misunderstood) statistics to infer that a diagnostic system he does not understand is flawed. However, true to character, he manages to end his essay with faulty logic, deciding to challenge the fact that contradicts his theory with an unsubstantiated (and wrong) generalization, and then an open question, which again doesn’t tell you anything.
In conclusion, Chinese Medicine has been used in China for thousands of years with success. At this point in time, they spend a fraction of the amount the US does on health care, and yet get decent results. In China, people who do not participate in the medical system have a marked decline in health, and unlike in the US, old people are able to walk outside and interact with society instead of being confined to a nursing home. Some of the concepts in Chinese medicine are difficult to understand with the Western model of thought, or squeeze through a reductionist model of double blind trials, but Barrett is essentially asking you, through a series of illogical attacks to ignore the results of the system in China, and accept that if medicine cannot explain the subject, it is flawed and quackery.
I believe quackwatch exists not to be a site of absolute truth and objective truth, but rather one negatively biased against alternative medicine which presents credentials and gives of an aura of prestige. By doing so, it makes it possible to have a citable source for countering alternative medicine, which can be used to give validity to any unsubstantiated claim attacking a health practice. If an impressive sounding statement is repeated, no matter how false it sounds it will eventually be perceived as truth. I hope by writing this, I have given you an insight into the non objective style employed by quackwatch to discredit certain topics. When I have time I’ll respond to another one.
