Physician and blogger Harriet Hall, MD, once coined an exceptionally apt phrase to describe research in many alternative medicine modalities – “Tooth Fairy Science”; it refers to research undertakings into a phenomenon whose existence is yet to be established. In a post in her blog Science-based Medicine, she explained:
You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.
Priceless. And of all the modalities championed by modern peddlers of pseudoscience, acupuncture most certainly qualifies as a prime example of Tooth Fairy Science.
Acupuncture is a procedure under the system of Traditional Chinese Medicine (TCM), which involves shallow insertion of needles into the skin at specific points. This system relies on quaint notions that mix pre-scientific ideas about physiology and disease with Eastern mystical philosophy. In TCM, diseases are considered to stem from a disharmony between yin and yang, two abstract ideas that are supposedly complementary in nature; this disharmony may result in blocking of the flow of a vital (life) energy, known as Qi (pronounced ‘chi’), along mystical pathways called meridians. Acupuncture supposedly unblocks Qi flow through meridians, resulting in the balancing of yin and yang, and consequently, cure. Never mind that no one has measured Qi ever, or that there are no anatomical structures that correspond to the prescribed locations of the meridians.
Acupuncture is currently the darling of the media as well as many Complementary and Alternative Medicine (CAM) professionals. Its popularity is attested to by the fact that many of the well-known medical centers and hospitals in the US are increasingly offering acupuncture as a therapeutic option. This situation per se is utterly amazing, considering that all the actual research involving acupuncture done till date seem to corroborate the hypothesis that it is nothing more than an elaborate placebo.
There is no dearth of studies on Acupuncture; a casual PubMed search of the term “Acupuncture” yielded more than 8000 English-language primary research articles (including clinical trials) and close to 2000 reviews (including meta analyses). Many of these studies have made extraordinary claims about the efficacy of acupuncture and related procedures in a variety of diseases and disorders. However, careful and meticulous scrutiny of these studies, as well as those claims, have often demonstrated that many of these studies are poorly designed or carried out, and that the claimed outcomes are based on wishful thinking on part of patients (a.k.a. conditioning) and investigators, as well as ignorance about the action of placebos and how inaccurate placebos can confound the interpretation of data. These have often necessitated prodigious hand-waving and post hoc rationalizations in the discussions.
One of the common themes that most studies in alternative medicine adhere to is that they are often NOT published in high-quality, prestigious, peer-reviewed journals. This observation, while attributable to the lack of rigorous science in those papers, have nevertheless engendered within the alternative medicine community the suspicion of a conspiracy. Rational researchers, dealing with empirically sound science-based medicine, are by and large content solely with the critical deconstruction of the absurd claims by CAM proponents, bolstering their arguments with published and verifiable experimental evidence and analysis.
Imagine my surprise, then, when I became aware of a relatively recent study claiming efficacy of acupuncture and offering a mechanism of action in… [Wait for it…]
The study was republished as a part of a recent Nature Supplement on Traditional Asian Medicine. Curiously, the issue appeared to be sponsored by two entities which have a significant financial interest in the field of alternative medicine. There is, of course, no law that prohibits such an entity from advertising or popularizing its products, but that a premier scientific journal like Nature should be an instrument to such promotion of pseudoscientific modalities raised quite a few eyebrows. Physician and Scienceblogger Orac has eloquently expressed his outrage, which has found echoes in the skeptical blogosphere and Twitterverse. In this post, I, however, would restrict myself to discussing the study by Goldman et al., that appeared in the July 2010 issue of Nature Neuroscience. The study postulates that “Adenosine A1 receptors mediate local anti-nociceptive (i.e. pain reducing) effects of acupuncture.”
To be continued… in Part Deux! [Suspenseful Music]