Raz: Crippled.

[Fate]

Try to get a double blind randomized control study for effectiveness on most of their "procedures". It never happens because they don't want their practices put under the same microscope of scrutiny that aspirin or any other medical intervention is put under. They do not believe in the scientific method.

How would you do a double-blind study of chiropractic procedures?  What would you do to the control group, crack their knuckles?

Essentially, yeah. You'd use sham procedures.

I see at least two obvious problems.  How would control group participants be fooled?  It's hard to perceive a spine being cracked without having your spine cracked.  Secondly, double-blind means that those administering treatment should be unaware as well.  How can someone administering spinal adjustment ever be unaware of whether he's supposed to do the real thing, or crack just for show?

I don't know enough about their pseudoscience to make a proper study. Presumably you can do chiropractic manipulation "wrong." Or maybe there's no wrong way,  which honestly wouldn't surprise me given that it doesn't use peer reviewed science to support its practices.

You'd probably have to use first time patients who haven't been to a chiropractor before so they wouldn't know what they "should" be getting. Or you can just put them under during the procedure, but I'm sure that messes up the energy fields or chi lines. Although that removes the power of their bullshit because it's all about conscious manipulation.

The study could still be double blind - the patient doesn't know which treatment they're receiving and the researchers don't know which patients received which treatment. The person giving the treatment is kind of irrelevant in terms of blinding. We double blind so that we can minimize bias on the part of the researcher.

[DGuller]

I don't know enough about their pseudoscience to make a proper study. Presumably you can do chiropractic manipulation "wrong." Or maybe there's no wrong way,  which honestly wouldn't surprise me given that it doesn't use peer reviewed science to support its practices.

You'd probably have to use first time patients who haven't been to a chiropractor before so they wouldn't know what they "should" be getting. Or you can just put them under during the procedure (which I'm sure messes up the energy fields or chi lines and renders a proper pseudoscience study invalid since there's no way to consciously manipulate them, which is what most scam artists do to achieve the placebo effect.) The study could still be double blind - the patient doesn't know which treatment they're receiving and the researchers don't know which patients received which treatment. The person giving the treatment is kind of irrelevant in terms of blinding. We double blind so that we can minimize bias on the part of the researcher.

I thought the point of double-blind studies was to also blind someone administering the treatment, to avoid him tipping off the patient, on purpose or inadvertently.

[Fate]

I don't know enough about their pseudoscience to make a proper study. Presumably you can do chiropractic manipulation "wrong." Or maybe there's no wrong way,  which honestly wouldn't surprise me given that it doesn't use peer reviewed science to support its practices.

You'd probably have to use first time patients who haven't been to a chiropractor before so they wouldn't know what they "should" be getting. Or you can just put them under during the procedure (which I'm sure messes up the energy fields or chi lines and renders a proper pseudoscience study invalid since there's no way to consciously manipulate them, which is what most scam artists do to achieve the placebo effect.) The study could still be double blind - the patient doesn't know which treatment they're receiving and the researchers don't know which patients received which treatment. The person giving the treatment is kind of irrelevant in terms of blinding. We double blind so that we can minimize bias on the part of the researcher.

I thought the point of double-blind studies was to also blind someone administering the treatment, to avoid him tipping off the patient, on purpose or inadvertently.

I mean your nurse knowing she's injecting experimental chemo vs gold standard chemo doesn't change the study results. Of course she can't tell the patient what she's injecting, but that is still the patient side of the blinding. The double in double blind comes from the researcher. If the researcher knew who was getting what treatment as the study was going on they'd consciously or subconsciously bias the outcome. So we give a third party the "key" and only unmask who got what after the study has been completed.

[DGuller]

The way it was explained to me in the high school statistics class, the nurse shouldn't be informed, because she can tip off the patient by her demeanor when administering treatment or placebo.

[Fate]

The way it was explained to me in the high school statistics class, the nurse shouldn't be informed, because she can tip off the patient by her demeanor when administering treatment or placebo.

It does impact outcome but that's the patient side of things. The patient knows what treatment they're getting so they behave differently. Single blinding is an effort to prevent the patient from knowing what treatment they received.

A double blinded study isn't one where the nurse is unaware of the treatment, the patient is unaware of the treatment, the researcher is aware of the treatment. That would be a single blinded study. I guess your class might have been conflating the researcher and the person administering the treatment, but they don't necessarily have to be the same person, and they usually aren't.

[DGuller]

The way it was explained to me in the high school statistics class, the nurse shouldn't be informed, because she can tip off the patient by her demeanor when administering treatment or placebo.

It does impact outcome but that's the patient side of things. The patient knows what treatment they're getting so they behave differently. Single blinding is an effort to prevent the patient from knowing what treatment they received.

A double blinded study isn't one where the nurse is unaware of the treatment, the patient is unaware of the treatment, the researcher is aware of the treatment. That would be a single blinded study. I guess your class might have been conflating the researcher and the person administering the treatment, but they don't necessarily have to be the same person, and they usually aren't.

Ok, I'll take that.  My objections still stand, they just apply to even single-blind studies.  You still would prefer the guy doing the cracking to be in the dark as to whether he cracks for treatment, or cracks for placebo.  That seems to be downright impossible, because snapping spines is not like giving pills.

[grumbler]

I'm very happy that this worked out well for you grumbler. 

I know several people who have had very positive experiences in dealing with chiros as well.

The problem is that there are people who also swear by the healing power of prayer, or tiger penises, or whatnot.  That's why we rely on Fate's new favourite phrase "evidence-based" treatments.

The studies done don't seem to support chiro manipulation as having any particular benefit.

Here's the best study I could find for free online.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447290/

I am perfectly willing to accept the idea that what I experienced isn't typical, which is why I couched my conclusion so carefully. 

I have never recommended that anyone undergo chiropractic treatment.  I simply noted my one experience with it.  If that was a scam, then I am happy I was scammed.  If it was just the placebo effect, then I am happy I experienced the placebo effect.  All I know is that ten months of pain disappeared completely and permanently after something like ten days.

I think your study should be examined by anyone thinking about undergoing chiropractic treatment, and I am delighted that I never saw it before I did so myself! 

[Darth Wagtaros]

How about acupuncture?

[CountDeMoney]

How about acupuncture?

He thinks chiro is a shame; you think he's going to fall for Tiger Penis Soup?

[Fate]

How about acupuncture?

Are there any randomized control trials supporting its efficacy? I mean it's not that medical doctors are intrinsically against traditional practices in all forms. But if we're going to use a medical intervention on a patient, there has to be a proven benefit. I tried doing a quick search and couldn't find any studies major US studies that show a statistically significant benefit of acupuncture versus sham acupuncture. At the very least we can say it's not harmful, so we won't tell a patient to avoid doing it if they believe it is helpful.

The placebo effect is quite powerful for subjective symptoms (which mean things like pain, malaise, feeling "bad", etc.) Up to 20-30% of people may observe a beneficial relief by sugar pill so as long as you tell them it will cure the subjective symptoms that they are describing. It's the same phenomenon with acupuncture and chiropractors.

[Darth Wagtaros]

How about acupuncture?

Are there any randomized control trials supporting its efficacy? I mean it's not that medical doctors are intrinsically against traditional practices in all forms. But if we're going to use a medical intervention on a patient, there has to be a proven benefit. I tried doing a quick search and couldn't find any studies major US studies that show a statistically significant benefit of acupuncture versus sham acupuncture. At the very least we can say it's not harmful, so we won't tell a patient to avoid something. The placebo effect is quite powerful. Up to 20-30% of people may observe a beneficial relief by sugar pill as long as you charge them a lot of money and tell them it will cure the subjective symptoms they are describing. It's the same with acupuncture and chiropractors.

Yes.

[Fate]

Yes.

It's a randomized control trial. You don't pay to take the sugar pill. The researcher pays you, or at least provides treatment for free. 

[Jacob]

According to the first google hits I got for "randomized acupuncture control trial", it seems acupuncture rates as being somewhat effective (varied from "moderate" to "positive but not statistically significant in this study". I'm not sure how credible the studies are, but here they are:

http://www.ncbi.nlm.nih.gov/pubmed/18065731

RESULTS:
The mean number of hot flashes per day was reduced from 8.7 (standard deviation [SD], 3.9) to 6.2 (SD, 4.2) in the true acupuncture group and from 10.0 (SD, 6.1) to 7.6 (SD, 5.7) in the sham group. True acupuncture was associated with 0.8 fewer hot flashes per day than sham at 6 weeks, but the difference did not reach statistical significance (95% CI, -0.7 to 2.4; P = .3). When participants in the sham acupuncture group were crossed over to true acupuncture, a further reduction in the frequency of hot flashes was seen. This reduction in hot flash frequency persisted for up to 6 months after the completion of treatment.

CONCLUSION:
Hot flash frequency in breast cancer patients was reduced following acupuncture. However, when compared with sham acupuncture, the reduction by the acupuncture regimen as provided in the current study did not reach statistical significance. We cannot exclude the possibility that a longer and more intense acupuncture intervention could produce a larger reduction of these symptoms.

http://www.ncbi.nlm.nih.gov/pubmed/16178942

RESULTS:
Patients who received only medical management did not demonstrate improvement in any of the standardized measures. Daily pain severity scores trended downward but did not differ between treatment groups (P= .60). Relative to medical management only, medical management plus acupuncture was associated with an improvement of 3.0 points (95% CI, 1.0 to 4.9) on the Headache Impact Test and an increase of 8 or more points on the role limitations due to physical problems, social functioning, and general mental health domains of the Short Form 36 Health Survey. Patients who received acupuncture were 3.7 times more likely (CI, 1.7 to 8.1) to report less suffering from headaches at 6 weeks (absolute risk reduction 46%; number needed to treat 2).

CONCLUSION:
Headache-specialty medical management alone was not associated with improved clinical outcomes among our study population. Supplementing medical management with acupuncture, however, resulted in improvements in health-related QoL and the perception by patients that they suffered less from headaches.

http://www.cmaj.ca/content/184/4/401.abstract

RESULTS:
Compared with patients in the control group, patients in the acupuncture groups reported fewer days with a migraine during weeks 5–8, however the differences between treatments were not significant (p > 0.05). There was a significant reduction in the number of days with a migraine during weeks 13–16 in all acupuncture groups compared with control (Shaoyang-specific acupuncture v. control: difference –1.06 [95% confidence interval (CI) –1.77 to –0.5], p = 0.003; Shaoyang-nonspecific acupuncture v. control: difference –1.22 [95% CI –1.92 to –0.52], p < 0.001; Yangming-specific acupuncture v. control: difference –0.91 [95% CI –1.61 to –0.21], p = 0.011). We found that there was a significant, but not clinically relevant, benefit for almost all secondary outcomes in the three acupuncture groups compared with the control group. We found no relevant differences between the three acupuncture groups.

INTERPRETATION:
Acupuncture tested appeared to have a clinically minor effect on migraine prophylaxis compared with sham acupuncture.

http://www.hindawi.com/journals/ecam/2012/309762/

5. Conclusion

According to this study, acupuncture is a highly acceptable adjunctive medical modality that could be integrated into current hospital systems. However, in this already short-stay population, it was unable to reduce length of stay.

[Capetan Mihali]

I suggest Neurontin (gabapentin), they prescribe it for just about everything, and it's not scheduled (unlike its close cousin Lyrica [pregabalin] which is Schedule V, iirc).

[Fate]

According to the first google hits I got for "randomized acupuncture control trial", it seems acupuncture rates as being somewhat effective (varied from "moderate" to "positive but not statistically significant in this study". I'm not sure how credible the studies are, but here they are:

Hmm. Alright, the main resource physicians go to these days for meta-analysis of all of the studies out here is a service called UpToDate. It's behind an institutional pay wall so I can't link it directly, but here's their verdict on the whole body of evidence for acupuncture.

Summary — These studies suggest that there is little difference in the effects on pain between acupuncture and sham acupuncture. A meta-analysis of randomized controlled trials of acupuncture for pain that included both sham acupuncture and no treatment arms (three-armed trials) found that the superiority of acupuncture over sham acupuncture, if real, appeared to be too small to be clinically important [114].

One likely explanation for the results is that both acupuncture and sham acupuncture moderate pain through a strong placebo effect. An alternate possibility is that sham needling at nonacupuncture points to minimal depths has physiologic effects on pain. Against this latter possibility is the result of a randomized trial that examined the effects of acupuncture and sham acupuncture on postoperative nausea and vomiting [62]. This trial used a sham device that did not penetrate the skin and still found similar effects with acupuncture and sham acupuncture.

As discussed above, it is difficult to know whether acupuncture constrained by the requirements of a clinical trial has the same efficacy as when it is performed according to the practitioner's preferences. However the marked superiority of acupuncture and sham acupuncture over untreated controls demonstrates the strong effects of treatment seen even under study conditions.

So do acupuncture, sham acupuncture, magnet therapy, chiropractic manipulation, rain dances, prayer, or sugar pills. It'll have more benefit for subjective symptoms (e.g. pain) than doing nothing. But it's likely that acupuncture isn't what's relieving the person's symptoms given that there is little to no benefit over "sham" acupuncture (defined as needles at non-traditional points, without proper penetration.) The belief that an intervention can provide relief can result in the patient feeling relief when you're dealing with subjective symptoms rather than objective symptoms.