The Conversation acupuncture piece triggers a prickly debate

Neil OConnell and Lorimer Moseley just wrote this piece for The Conversation ‘Acupuncture research – the path least scientific?‘ and it triggered some pretty heated debate – The Conversation stopped comments for fear of the abuse getting beyond what they see to be appropriate for the public space.

It is indeed amazing to see how fired up and off-topic people get, and also how the main message of a piece can be lost when it clangs against core beliefs – reminds me of a good mate, Johnno Riley, who said ‘You can’t argue doctrine’.

Not to speak for Neil here, but I for one am actually convinced that there is some magic that happens when an expert Acupuncturist treats someone in pain – indeed in any off-health state. However, I am also satisfied that the magic is not in the needles or where they are put. So, this makes for some exciting experiments – what is the magic? Can we get a sufficiently good handle on it to use it clinically?

I wrote a short letter on this some time ago in the BMJ and Dr Steve Kamper and Dr Chris Williams have written a lovely piece soon to star here on BiM. So check out our prickly number in The Conversation and wait for their blog in just a wee while…..

About Lorimer Moseley

Lorimer Moseley1 280x300 The Conversation acupuncture piece triggers a prickly debateLorimer is NHMRC Senior Research Fellow with twenty years clinical experience working with people in pain. After spending some time as a Nuffield Medical Research Fellow at Oxford University he returned to Australia in 2009 to take up an NHMRC Senior Research Fellowship at Neuroscience Research Australia (NeuRA). In 2011, he was appointed Professor of Clinical Neurosciences & the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide. He runs the Body in Mind research groups. He is the only Clinical Scientist to have knocked over a water tank tower in Outback Australia.

Link to Lorimer’s published research hereDownloadable PDFs here.

Comments

  1. The magic that happens in the treatment encounter is the interesting research. It is one of the things Benedetti is on about in “The Patients Brain” is it not.

    If we can focus on why so many disparate treatments can work in certain conditions, perhaps we can start chucking the mumbo jumbo and evolve what happens when people in pain seek treatment. No matter who they seek. Why do we need to “Stab Tinkerbell” to do that? (hat tip to Barrett Dorko at http://www.somasimple.com).

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  2. Andrew McMullan says:

    or the Method is not the the Trick – http://www.ncbi.nlm.nih.gov/pubmed/20710090

    ANdy

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  3. Dr theodore jordan says:

    I am a physiican. My brother is an acupuncturist. He worked for many uears in a drug rehab program, where I watched him work several times. Drug addicts (mostly crack & heroin), would come in in withdraw. He would pop in two needles in one of their ears, and within seconds they would relax, stop tremoring, stop sweating, breath fully, etc. Wow. I have never seen anything like this in medicine. It may all be placebo – they know what the expected effect is, and needles make great placebos. Then again, maybe there is something more physiologically going on. I really don’t know. But even if acupuncture is all placebo, it is healping a lot of addicts get over their addiction – and thats pretty cool.

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  4. Dear Lorrimer
    Your letter to the BMJ struck home; in particular when you say “get
    excited about what else might have led the patient’s brain to conclude that the need for symptoms had just reduced”. Should “placebo” be such a dirty word, if it is helping people to recover? As an aside, there are similar visceral debates to those seen on The Conversation surrounding ‘energy medicine’ in general on the UK’s Chartered Society of Physiotherapy web forum.

    In relation to “the magic” I was reminded the other day about Dr Michael Balint’s book – The Doctor, His Patient And The Illness. (1957)
    Within the introduction he puts forward the following in relation to a seminar on what drugs were usually prescribed to patients:
    “by far the most frequently used drug in general practice was the doctor
    himself, ie. it was not only the bottle of medicine or the box of pills that mattered, but the way the doctor gave them to his patient – in fact the whole atmosphere in which the drug was given and taken.”*
    This could equally apply to acupuncture.

    I realise I am laying myself open to equally visceral criticism here, but maybe what happens when metal and flesh interact is more to do with helping to reshape a distorted virtual body / body schema which assists the brain in reducing symptom output. (Hmmm, but how could we prove that?)

    *Balint M. The doctor, his patient and the illness. 2nd ed. Churchill Livingstone, Edinburgh, 1963 [Reprint 2003].

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  5. Dave Nolan says:

    The placebo sure can be a great effect and I think we all tap into this when treating patients, and we would be daft not to. I think it becomes an issue when we no longer search for a deeper understanding of why something works. As if we want to advance the profession and start to help people who are suffering with pain which we at present can do little for, then we need an appetite for advancing our knowledge and changing our practice as we do so.

    To often I see patients given a course of acupuncture to “give it a go see if it works”. No attempt to understand the problem, no attempt to engage the patient. We have all this wonderful knowledge now that has come about in the last 10 years, we need to embrace it, run with it. Now to me this does not mean to stop using acupuncture or any other placebo intervention but change the context, change how to apply what we do. Change out explanation to make the patients see the magic is them not us. Use this window of opportunity of reduced pain to refresh your homunculus and reduce your fear of movement. Inspire them, don’t frighten them.

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    Byron Selorme Reply:

    Dave, that is a brilliant way of putting it.

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  6. Neil Pearson says:

    Well stated Lorimer. It will be interesting to see if this situation is similar for other needling techniques – such as prolotherapy and intramuscular stimulation.

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  7. I appreciate one of the contributors here mentoning the letter to the editor I co-wrote with Jason Silvernail. The point of this is that the way in which something is done is only part of the solution and may be some distance from other aspects of the process, many of them unknown, mysterious (in a way) and always worthy of further discussion and subtle alteration in application.

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  8. I think that the miracle of acupuncture can be that you are doing something that initially hurts a patient (da qi) with an expectation of improvement in symptoms and a confidence that it is unlikely to harm them (unless you start playing mindlessly around the chest wall or start re-using needles). I think that the confidence, charisma, compassion … that an experienced practitioner has is critically important (Bogduk’s 5 C’s of effectiveness). The studies that have shown that there was increased effectiveness with Asian male acupuncturists with Asian patients were fascinating. In terms of the autonomic effects, and why it worked for the addicted patients mentioned previously, I am unsure but impressed. As well, with patients with CRPS, I would say it rarely, if ever, has much lasting effect. Yes ?

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