Download Lectures on Biostatistics (1971). Corrected and searchable version of Google books edition
Download review of Lectures on Biostatistics (THES, 1973).
Systems biology is all the rage, No surprise then, to see the University of Westminster advertising a job for a systems biologist in the The Department of Molecular and Applied Biosciences. Well, no surprise there -until you read the small print.
Much has been wriiten here about the University of Westminster, which remains the biggest provider of junk sciencne degrees in the UK, despite having closed two of them.
 Senior Lecturer in Systems BiologyUniversity of Westminster – Department of Molecular and Applied Biosciences, School of Life SciencesCavendish Site Salary £37,886 – £50,751 (Inc. LWA) The Department of Molecular and Applied Biosciences wishes to appoint a Senior Lecturer in Systems Biology. The post-holder will teach on the undergraduate and postgraduate degree programmes within the School of Life Sciences, particularly in the areas of Molecular Biology, Bioinformatics and/or statistics, establish their own and participate in ongoing research programmes and undertake external income generation activities. The candidate should have an active interest in bridging the gap between western life sciences and Chinese medicine using emerging systems biology approaches, specifically in metabolomics and proteomics with a goal of developing novel diagnostic technologies facilitating the creation of a personalised approach to medical care. They should therefore be willing to work closely with colleagues in the life sciences as well as with clinicians and clinical researchers from within the East Asian medical tradition. The post is available from 1st October 2010 or as soon as possible thereafter. The closing date for applications, together with a short statement on why you believe you are suitable for the position and a description of your research plans, is Monday 6th September 2010. Interviews are expected to be held later in September. Administrative contact (for queries only): Tayjal Tailor (t.tailor1@wmin.ac.uk) Reference Number: 50000360 Closing Date: Friday 3 September 2010 |
A note about systems biology
Systems biology is about about how whole organs behave, as opposed to single cells or single molecules, It has to be the ultimate aim of biology. There is one case in which this has been done with some success, That is the modelling of the behaviour of the whole heart by Denis Noble and his colleagues in the Phyiology department (now gone) in Oxford. They adopted a bottom up approach. They measured the currents that flow though many sorts of ion channels in single cells from various parts of the heart, and how individual cells communicate with each other. Starting from this solid basis, together with a lot of computer power, they were able to model successfully a lot of phenomena that occur in the whole heart, but can’t be investigated in single cells. For example their work cast light on abnormal heart rhythms like ventricular fibrillation, and on the effect of drugs on heart rhythm.
This work was mostly done before the term ‘systems biology" thought of. It was called physiology. It is impressive work, and systems biology became a fashionable buzzword among research administrators and funding agencies. Despite the amount of money thrown at the problem, I’m not aware of any success that remotely approaches Noble’s.. One reason for that is that people have not been willing to put in the groundwork. In the case of the heart, the models were built on -many years of basic research on the electrophysiology of single heart cells. People have tried to model from the top down, without doing the spade work first. There has developed a perception that computing power can compensate for lack of basic knowledge about things work. It can’t. The usual aphorism applies: garbage in, garbage out.
Here’s an example, which eas noted in the diary pages for 29 June, 2008. While in Edinbuurgh, to give a talk to the European Conference on Mathematical and Theoretical Biology, I noticed a poster. It described an attempt to model on a computer the entire metabolic network of yeast.
“81 of the 662 intracellular concentrations were defined . . . The remainder were set to the median concentration of c. 0.2 mM.”
Ahem. We didn’t know the concentrations so we just made them up so we could run the program.
It’s interesting that even people in the business seem to realise that even that it isn’t living up to the hype. The Fixing proteomics web site shows why.
Put another way, if you try to run before you can walk, you risk falling falling on your face.
For these reasons, it seems to me that that most attempts at system biology have been disappointing (please correct me if I’m wrong)
Systems biology for Chinese medicine
If systems biology suffers from trying to run before it can walk in regular biology, where at least something is known about the functions of cells, how much more true that must be of Chinese medicine. In Chinese medicine almost all the treatments have never been tested properly in man. The odds are that most don’t work at all, and some are very poisonous (not to mention the cruelty and destruction of endangered species that is involved in making some of their more bizarre medicines). The idea that you can explain it with systems biology, is ludicrous in the extreme.
One can’t imagine any vaguely competent biologist who’d want to touch a project as bizarre as this with a bargepole.
Eastmedicine
This advertisement stems presumably from EASTmedicine is the University of Westminster’s research centre for East Asian Sciences and Traditions in Medicine. The proclaimed aims are to focus on “understanding, development and evaluation of East Asian medicines as living traditions”. The director of EASTmedicine, Volker Scheid, is a herbalist and acupuncturist and, as such, a firm believer in alternative medicine. When he isn’t at the University he has a private practice, the Traditional Acupuncture Centre, in London.
The website of his private practice makes some astonishing claims
"Acupuncture is effective in the treatment of numerous conditions including headache, migraine, digestive problems, menstrual disorders, indeterminate aches and pains, asthma, hayfever, stress, tiredness, depression and anxiety. Also commonly treated are chronic conditions such as arthritis, back pain, ulcerative colitis, irritable bowel syndrome, eczema, sinusitis, high blood pressure and repetitive strain injuries."
These claims simply cannot be justified by any worthwhile evidence. It will be interesting to see what Trading Standards make of them.
Dr Scheid describes himself as a "scholar physician". Physician seems a rather pretentious description for someone whose qualifications are stated to be PhD, MBAcC, FRCHM. But in similar vein he describes himself thus "I am one of the West’s leading experts on Chinese medical formulas and treatment strategies".
Although Scheid sells acupuncture treatments to patients, he seems ro be more anthropologist than medical. In a discussion of two acupuncture papers
"From the Perspective of the Anthropologist –
Volker Scheid, London, UK
From a perspective anchored in the cultural studies of science, technology and medicine my main interest in these papers is their status as cultural artifacts that provide access to the lifeworlds of a particular research community. If any, life-world debate and argument marks sites of contestation." Forsch Komplementärmed 2007;14:371–375
Scheid shows not the slightest interest in whether acupuncture works other than as a placebo. Since he is selling acupuncture, he presumably starts from the premise that it works.
Volker Scheid has had a £205,000 Wellcome Trust for the History of Medicine Project Grant: 2009 2012; Treating the Liver: Towards a Transnational History of East Asian Medicine; There’s nothing wrong with writing the history of long-outdated systems of medicine, though one could hardly imagine that the history would be very impartial, when it is written by a true believer. Another taste of his style can be found in his paper on Globalising Chinese Medical Understandings of Menopause. There is lots of rather pretentious stuff about culture, but very little about what actually works, Towards the end of the paper we come to the usual feeble excuse.
" . . once traditional medicines allow themselves to be evaluated by biomedical research methods, the odds against receiving fair treatment are heavily stacked against them."
The translation of that into plain English is something like ‘when we test our treatments properly we find they don’t work, so we blame the methods and carry on with selling them anyway’.
Judging from its web site, EASTmedicine does not to do any serious clinical trials to test whether the treaments work in man, They just know that they do. But they are hoping to add some spurious scientific background to their dubious claims by hiring someone to do compuations that will cast no light whatsoever on the question that really matters, Do they work or not?
The agenda is made clear by the statement
EASTmedicine seeks to describe and analyse the dynamics of these transformations with a specific view of managing their integration into contemporary health care.
So it is just yet another group of people pushing to have unproven and disproved treatments accepted by real medicine.
The University of Westminster appears to be determined to make itself the laughing stock by persisting in promoting junk science at a time when most other universities have realise that the harm done to their reputations is not worth the income it generates, Plenty of it has been revealed here.
The vice-chancellor of Westminster, Prof Geoffrey Petts, made into the pages of Private Eye (see Crystal balls. Professor Petts in Private Eye when he announced that he wouldn’t get rid of the junk, but would make it more ‘scientific’. Well, credit where it’s due, They have dropped homeopathy. see The last BSc (Hons) Homeopathy closes! But look at what they still teach at Westminster University For 2010 they still off ten different “BSc (Hons)” degrees in pre-scientific forms of medicine. It will take more than a bit od talk about systems biology to make anyone believe that these courses have anything to do with science.
For example, look at some slides from their lectures on “energy medicine”, Westminster University BSc: “amethysts emit high yin energy”
More make-believe from the University of Westminster. This time it’s Naturopathy , or
Why degrees in Chinese medicine are a danger to patients
The Dean of the School of the Life Sciences, Jane Lewis, is an entirely respectable marine biologist. She has had the thankless task of merging the real science with the alternative medicine in a single school. I phoned her to get a reaction
" outcome of merger of the school and trying to bring various parts of the school together" " "things are much more rigorous than they were".
DC: "Why don’t you just phase it out?"
"I’m not in a poition to do that. i move things forward as seems best -for the whole school I have to say". We’re retaining those bits thatI think have some good standing -I see NICE has approved the use of acupuncture for lower back pain and some other bits and pieces so I see acupuncture as something that does have some standing, andwe make sure it rigorously taught"
"DCHave you looked at the stuff on naturopathy?" "Are amethysts emit high Yin energy still taught?" " i don’t think so".
It seems, as so often in this case, that the senior people don’t really know what’s being taught under their noses. Prof
Lewis says she has not read about the background
to the (unusually) daft advice from NICE. Neither has she read Barker Bausell’s book on acupuncture research. If she had done any of these things,I suspect she would not have such a high opinion of it as appears to be the case.
Bait and switch. Astonishingly there is a now a whole organisation devoted to the respectabalisation of Traditional Chinese Medicine Good Practice in Traditional Chinese Medicine Research in the Post-genomic Era It sounds nice and sciencey but, as usual, they are trying to run before they can walk. The first thing has to be to do good clinical trials to find out if there is anything there to be investigated. If, and only if, this is the case, would there be any case for fancy talk about "proteomics"
and "the post-genomic era".
I do hope that no funding agency would be fooled into parting with money on the basis of the present vacuous rhetoric.
Professor Lewis said that I have I have quoted things like "amethysts emit high Yin energy" out of context. There is a simple solution to that. I have asked Westminster to make available the entire contents of the courses. Then we shall all be able to see the context of what their sudents are being taught.
Follow up
A brief report of this matter has appeared in Times Higher Education. In a statement, the University of Westminster says “its research into Chinese medicine is following the lead of “top research institutions”. I’m not aware of anyhting quite like this from anywhere else. In any case, Westminster should be able to think for themselves.
37 Responses to Emergent Chinese Omics at the University of Westminster
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Using George Lundberg’s criteria (See Improbable Science Dudistan 25/8/10 #129) it seems that TCM has yet to establish itself as a safe and effective treatment.
Systems biology seems a bit like the emergent form thing. The analogy here is like uncovering the rules of chess from the chess pieces and their movements only. One would have to notice that there were 32 pieces in two different colours, learn to recognise the pieces – knight and bishops and so on, (difficult because all chess sets are not identical) study how the different pieces moved if at all, how the pieces were laid out at the start. Tough job & one could easily be distracted by the way the board was glued together!
If TCM simply does not do what it claims it does, then there is a big chance of no game & no rules to be studied!
As far as i am concerned these guys have got a monopoly board, half a chess set, some beans, sweeties and other remnants of a big party! But no proof of a game.
All that was a bit long winded. What I mean to say is that if TCM/acupuncture does not do what it claims to do then there is no point in studying it until it does.
ctl+W for now.
@andrew
I agree. The project “Good Practice in Traditional Chinese Medicine Research in the Post-genomic Era“, which involves people from Kings and Cambridge among many others, does not, as far as I can see, intend to do any clinical trials to find out what works, before they launch in to trying to discover how it works. In fact they seem to be proposing to spend three years, and large amounts of EU money, to write protocols for future research. It will be fascinating to see what the outcome of this project is in three year’s time. Any bets?
And, as far as I can see, Westminster is not proposing to find out what works either.
Buzzwords seem to be more powerful than a bit of common sense in both cases.
http://www.gp-tcm.org/2010/03/test-for-homepage/
“The overall aim of the project is to inform best practice and harmonise research of the safety and efficacy of Traditional Chinese Medicine (TCM) in EU Member States using a functional genomics approach through exchange of opinions, experience and expertise among scientists in EU Member States and China. ”
What the hell does that mean? Can I assume that this means they take their filthy herbal mixtures and drop them on cells or stick them in people and then see whether they express genes differently in response. This is equivalent to sticking an acupuncture needle into someone and asking whether it hurts and detecting electrophysiological changes in nerve cells.
Studies like that are guaranteed to generate results and look like real science, but they are a million miles a way from answering the relevant question of whether the products have useful clinical effects.
We get this in real medicine as well- companies keen to highlight the fact that their drug confers some theoretical benefit from its pharmacology even if that has not been shown to translate into real clinical benefit. An example would be showing that if you are given radiolabelled chondroitin the radiolabel can be found in your joints. This is not untrue, but has little bearing on whether your arthritic pain is reduced and the rate of deterioration of arthritis slowed.
Presumably there is big politics behind this- EU wanting to cuddle up to the Chinese.
@BadlyShavedMonkey
Yes precisely. It is sad that funding agencies should be taken in by such shallow and vacuous prose.
Almost all of the of the degrees in quackery come from the post-1992 universities, but many older universities have tolerates quackery in clinics and in ;research’. Even UCL has Freudian psychoanalysis.
Perhaps it is time for a blog on quackademics in the Russell group universities.
“Good Practice in Traditional Chinese Medicine Research in the Post-genomic Era“
Please tell me this is a spoof! Things seem to be getting worse not better.
As a long time reader (and first time comment poster); following on from @lindys comment, I’d love to know if DC and others here think that, overall, the situation is improving? Will quackery, masquerading as science be ultimately removed from academia? I had the impression that it was a long hard slog, but net progress was being made, not least because of DC and other bloggers tireless efforts- for example the closing down of several non-science Bsc courses. But I find these latest developments alarming. They will have the effect of making practises and techniques that belong in an anthropology museum, appear as cutting-edge, sophisticated science, (to those who don’t understand what science is). This is not good. Are we still moving in the right direction overall ? Keep up the good work.
@Brawnwilliams
That’s a good question and I wish I knew the answer. The new government certainly isn’t helping, but their attitude to rationality and evidence is probably no worse than new Labour’s (i.e. abysmal).
On the university front, it seems to be two steps forward and one step back. but that’s progress.. Vice-chancellors mostly seem to be sorely in need of IT classes. They seem unaware of the ever growing pressure from thinking sceptics. In the end. sheer embarrassment will have its effect I think.
Bringing your own university into disrepute is a serious offence, yet that is precisely what Prof John Brooks of Manchester Metropolitan and Prof Geoffrey Petts of the university of Westminster. Both have a scientific background, yet they allow this sort of thing to go on.
Gruesome. Westminster University?
University?? If I could stop vomiting I might laugh.
Volker Scheid appears not to be concerned about whether Chinese medicines work – in the sense we expect our medicines to work in here – but only concerned about the tradition of Chinese medical practice.
If too many practices are shown not to work that tradition will be undermined whilst those that do work will simply be accommodated into the biomedical paradigm.
Let it be so, please.
You make it sound like degrees in alternative medicine are Mickey Mouse. I’m afraid Minnie and Mickey would be more at home on a pharmacology or pharmacy course. I would say that about 85% of the herbal medicine degree was relevant to practice. Does your beloved pharmacology degree, David, have modules on pathophysiology,nutrition, differential diagnosis, business studies etc. No, I thought not. Me thinks that most academics need to leave the Magic Kingdom and have a spell in the real world.
@dangerous
I wonder where you plucked that 85% figure from. Plucked from thin air?
You are right, pharmacology degrees don’t usually include courses in differential diagnosis. Their aim is to teach science, not to produce pretend-doctors.
You may have made an important point though, when you mention business studies. Herbal medicine is business. The aim of making money is rather likely to make its practitioners less than critical about the efficacy of what they do, A critical spirit would reduce their income. Thanks to our wonderful NHS that is much less important in real medicine (though sadly it does creep in when Big Pharma bribes prescribers).
So differential diagnosis, phytochemistry, pathophysiology, diagnostic skills (conventional) and nutrition aren’t science?
I can only compare the herbal medicine degree I’ve just completed with the course on offer in pharmacy (at a Russell Group University) where I happen to do some teaching.
I loved your comments about the NHS not being about money. Having worked in nearly five hundred GP surgeries I can safely say that primary care is very much about money. Have you never heard of the Quality and Outcomes Framework (QoF) “points makes prizes” that Liarbour introduced? When I see patients in the NHS I have to go through a computer generated protocol to ensure that the practices get the maximum QoF points. Actually looking at the patient is a rare.
The NHS is wonderful! I nearly had to reach for the oxybutynin. We are now paying for a First World health service but getting Eastern European standards of care. As one German pharmacist said to me, “if we had your health service they’d be rioting in Berlin”.
Yes, there may be some newer PFI (65 billion of debt) hospitals but care for people with dementia or younger people with mental health problems is frankly awful.
@ Dangerous Conventional #10
May I ask what was in the business studies modules of your herbal degree please ? Business Studies covers a wide range.
#10
“You make it sound like degrees in alternative medicine are Mickey Mouse”
They are. I should know, I’ve got one.
They are completely lacking the academic rigour that is required in an orthodox science degree, and even an arts degree from a Russell Group university.
More like a heavily padded out O level.
It’s a disgrace. And a public con.
@Avoided Cranium
Thanks. You are not the only graduate of parallel universe degrees to express that opinion.
I haven’t got a degree in any sort of magic medicine. But it seems I’ve had some training. Tonight twitter led me to the “ Homeopathic Medicine Medical Quiz“. I scored 100 percent (OK, like any good quack, I cheated a bit -had to Google a couple of questions). Horrifying really to think how much time I’ve spent in the last few years absorbing this nonsense, when I could have been doing something useful.
@DC
I scored 60 without cheating.
@Avoided Cranium
I havent got an altmed degree, but I did complete a post-graduate acupuncture course for physiotherapists in 1991, which I updated in 2006.
On the original course we were taught the basic tenants of Chinese theory; meridians, Qi etc. The update course concentrated more on Western theories; endorphin release, pain gate theory etc.
I find it hard to believe that I fell for the Chinese hocus pocus for the best of my career as a physiotherapist.
I also shudder when I hear other PTs explaining to patients that they are receiving acupuncture to release stagnation in a particular meridian or to replenish the spleen.
It is frightening to me that so many members of my profession (remember that the biggest deliverers of acupuncture in the UK are NHS physiotherapists) are not sufficiently critical to see through the sham of altmed when they are so adept at applying science effectively in so many other clinical areas.
The “ Homeopathic Medicine Medical Quiz“. A lot of people (essentially all skeptics) tried this after it was publicised in Twitter -they all got 60 t0 90% The only one I didn’t know at all was Vithoulkas’s original training so I’d have been 80 or 90% without Google, In other words it seems that just about anyone can pass the test.
There’s a surprise.
Something jumped out of the above article: the title of Scheid’s project. I can’t take that seriously because it so closely follows the form of Sokal’s infamous parody paper, cf:
Treating the Liver: Towards a Transnational History of East Asian Medicine
and
Transgressing the Boundaries: Towards a Transformative Hermeneutics of Quantum Gravity
Brilliant!
In addition, if you were to say Prof Dr Scheid’s surname with the appropriate Germanic pronunciation, you might sounds like a Scouse (or Irish) sceptic offering a pithy critique of the whole concept of Emergent Chinese Omics
Before slagging off Systems Biology, let’s remember that University College London itself has a Systems Biology department. There are old timers who resist this approach, but quite clearly it has an important place in the future of biological sciences.
People who are worried about complementary medicine probably have a lot to be worried about when systems biology is employed. I’ll specifically discuss acupuncture in this connection. At present, a great deal of clinical research shows that acupuncture is clinically effective. The big question is not whether acupuncture does or doesn’t work, in many cases, but rather, why is it working? Skeptics are very fond of citing placebo response as the reason why acupuncture achieves clinical success to the extent that it does. While in actuality placebo effect, by definition, involves genuine healing, it is stigmatised as being a ‘fake’ sort of healing, ‘duping a gullible public’.
For people who like to rubbish acupuncture, dismissing it as based on placebo effect and by a tenuous association, a form of charlatanism, there is a very real threat that as the scientific mechanisms that are involved in its clinical effectiveness are better understood, that new understanding will supersede the all too convenient rhetorical put-down, ‘placebo’.
The problem, then, for skeptics who at present rely on dismissing the effectiveness of acupuncture as a placebo treatment is that scientific discovery threatens to undermine any glib dismissal of acupuncture as a placebo therapy.
A knee jerk reaction for those skeptics will be to try to persuade scientists to not conduct scientific research. It is much easier to dismiss acupuncture on the grounds that there is no scientific evidence to support it. As various types of evidence and scientific knowledge increase, from fields such as neuroscience and systems biology, that understanding is going to supplant what will become the outdated and crude concept of ‘placebo effect’, and sceptics are going to have to think hard how to justify their negativity to something known to have specific physiological healing effects.
@Joseph
Yes I’m quite aware that most places, including UCL, have an interest in systems biology. It is a pity that you don’t engage in the discussion rather than making blanket assertions.
The same applies to your arguments about acupuncture. It isn’t good enough to write off other people’s views as “knee-jerk reactions”. Please produce your evidence. How, for example. do you dismiss the views of Barker Bausell, or those of Sing & Ernst. The fact opf the matter is that many trails of acupuncture have been done (unlike the rest of Chinese medicine). Almost invariably “real acupuncture” comes out the same as sham. Even in no-blind comparisons of acupuncture vs no acupuncture, the advantage of the former is small and transient.
It is not clear to me that you have done your homework properly. Have you perhaps got some vested interest in perpetuating myths?
@ David Colquhoun
There is a profound need to maintain a maximum level of clarity when discussing these matters. At present, both individual clinical trials and systematic reviews are beset by inconsistencies in approach – for example different treatment protocols, different criteria for determining outcomes, different ways of handling statistics, etc., that it is very difficult, if not impossible, to make precise statements about research indicates. There is such a profusion of opinion that people’s conclusions are very much determined by prior assumptions.
A lot of the problem is that we are very lacking in an understanding of exact mechanisms involved in acupuncture. We know that such mechanisms exist, and new discoveries continue to be made. We already know that such discoveries can drastically alter our perception of acupuncture. For example, 40 years ago, for many people the notion that putting a needle in someone could modulate pain sounded laughable. Then the Gate Theory of Pain, and separately, the discovery that acupuncture needling stimulates the production of endorphins, turned that around. With those discoveries, acupuncture immediately could be seen as a treatment with real physiological effects, and importantly, those physiological effects provided at least the beginning of an explanation of how acupuncture could genuinely modulate pain via precise physiological pathways.
One of the constant themes of clinical trials into acupuncture is that it is clinically effective – it does yield therapeutic results. The problem is in determining why those results are obtained. ‘Sham acupuncture’ may also provide therapeutic results, and at times, these may be as good as what is called ‘real acupuncture’. But one has to make clear that it is hotly disputed what ‘real acupuncture’ is – there is no consensus whatever about this. In actuality, what is termed ‘real acupuncture’ varies considerably between different studies, and also from real life clinical practice. And secondly, what is termed ‘sham acupuncture’ is itself known to have physiological effects whose value is unknown. It is poor science to use a control something whose effects are not understood.
What researchers such as Dr. Volker Scheid are doing is opening the field of acupuncture to a much deeper scientific exploration.
@Jospeh
You may find the Wikipedia entry on Pain useful :-
http://en.wikipedia.org/wiki/Pain#Phantom_pain
“For example, 40 years ago, for many people the notion that putting a needle in someone could modulate pain sounded laughable. Then the Gate Theory of Pain, and separately, the discovery that acupuncture needling stimulates the production of endorphins, turned that around.”
But Wiki says : “The gate control theory has not fared well. Most of the dorsal horn interneurons identified by Melzack and Wall as inhibitory are in fact excitatory,[34] and Koji Inui and colleagues have recently shown that pain reduction due to non-noxious touch or vibration can result from activity within the cerebral cortex, with minimal contribution at the spinal level.[39”]
and also in the Alternative Medicine section of the Wiki entry “Pain is the most common reason that people use complementary and alternative medicine.[68][69] An analysis of the 13 highest quality studies of pain treatment with acupuncture, published in January 2009 in the British Medical Journal, concluded there is little difference in the effect of real, sham and no acupuncture.[70]”
I think Madsen etc all allowed for the different protocols and inconsistencies in approach you mention @ 22.
As far a systems biology/TCM acupuncture goes, I can’t see the logic in trying to establish how something works before establishing it works (or not!) at all. There are probably other and better starting points for systems biology.
@Joseph
I am in no doubt that acupuncture (Western or TCM) has mild analgesic and autonomic effects, largely due to the body’s temporary response to the stimulation of mylenated nerve endings.
The question for me is: are these mild neurohormonal effects any better than other pain relief treatments. e.g. paracetamol, distraction, heat etc.?
Probably not, but the added placebo effect of needling (on top of any small physiological effects) mark it out as a hot favourite for many patients.
The problem is the expense. Most acupuncture in the UK is delivered by NHS staff (far greater than the private sector).
It’s quite expensive and even if it has some mild physiological effects, it is questionable – on the basis of clinical research to date – whether there are any real medium to long term clinical benefits.
@Joseph
I fear you are quite wrong. We do NOT “know that mechanisms exist” because we don’t know whether there is anything there to explain. before you start looking for mechanisms you first have to show that it isn’t just a theatrical placebo. As more and more evidence accumulates, the more it seems that a theatrical placebo is all that there is.
You say also
But the briefest inspection of Scheid’s publications show that he isn’t a scientist at all (and judging by the fact that he makes money by selling acupuncture to the public, he has already made up his mind). He is an anthropologist and cultural historian, and he may well be good at that. But you can’t expect science from someone with those qualifications.
I’m inclined to wonder what the GMC would think of his own description of himself as a “physician”. If I were unwell, I don’t think I’d want to consult an anthropologist.
Systematic review conclusions , by condition, Feb 2008 – April 2010
The compilation below is extracted from Mark Bovey. ‘The Good, the Bad and the Masterful – Researching Practice. EJOM Vol. 6 No. 4 2010.
Each letter from A to D represents the degree of the positivity of the conclusions for systematic reviews for specific conditions, published February 2008 to April 2010. When there is more than one review per subject, they are presented in reverse chronological order. A is the most positive grade.
[Please note: there may be formatting problems transferring this information to this webpage.]
Psycho-emotional & addiction
Insomnia A, B, C, C
Depression/stroke B, B, A
Schizophrenia B
Dementia A
Opiate withdrawal A
Neurological & headache
Headache — chronic A
Headache — tension A, C
Headache — migraine A
Spinal cord injury B
Stroke rehabilitation B, C(moxa only), D
Stroke — dysphagia A
Stroke — shoulder hand syndrome B
Parkinson’s B, D
Meniere’s A
Cerebral palsy B
Gynaecological, obstetrics & male complaints
Polycystic ovaries B
Pregnancy — various B
Breech presentation A, A, A
Prostatitis A
Musculoskeletal complaints
Osteoarthritis B, A
Neck pain A
Back pain A, A
Temperomandibular A, B
Fibromyalgia A, C, D
Gastrointestinal disorders
Constipation B
Nausea & vomiting/chemotherapy B, C(moxa only)
Nausea & vomiting/post-operative A, A
Chronic fatigue syndrome A
Obesity A A
Pain/Post-operative B
Acne A
Rhinitis B, A, D
Please note that I have highlighted problems with research and systematic reviews in a previous message. However, I think that the high level of positive conclusions listed above, from relatively recent systematic reviews, shows that the facile rubbishing of acupuncture that is evident on this site is not warranted by actual clinical evidence, and indeed, these results show that there is a great deal of evidence for the effectiveness or efficacy of acupuncture.
The European Journal of Oriental Medicine shows shows the current issue as vol 6 No 3.
I guess we will have to wait for No 4 for Mr Bovey’s review.
@Joseph
It’s odd that reviews in CAM journals seem to come to quite different conclusions from those in the rest of the medical literature, Nothing to do with the fact that many authors in CAM journals are making a living from it, I hope.
@Joseph
I’m not sure DC is right in suggesting that ‘we do not know that mechanisms exist’.
Basic science research over the last forty years consistently demonstrates that stimulation of myelinated nerve endings in skin and muscle results in neurohormonal changes in the nervous system.
But then so does banging your big toe against a rock.
The fact that the body responds at all to sharp stimuli does not guarantee clinical benefit.
@ Dudeistan
You wrote:
“But then so does banging your big toe against a rock.
The fact that the body responds at all to sharp stimuli does not guarantee clinical benefit.”
Of course. But let’s look at this a different way. If you bang your toe against a rock and damage your toe, your body needs to know that and respond appropriately to repair the damage. There can be little doubt that these sort of responses to stimuli evolved precisely to stimulate healing to occur. So, the question with a treatment such as acupuncture is, is needling providing a form of stimulation that activates healing mechanisms?
Let’s assume, for a moment, that acupuncture does work in this way. (I’m not asking anyone to take this on blind faith – this is a provisional assumption, and the final answers can only be provided by painstaking scientific research.) If acupuncture does work by stimulating natural healing processes, than it provides a potentially valuable tool for investigating these mechanisms, which are currently very poorly understood. Research into acupuncture would not merely be valuable to understand acupuncture, but perhaps even more importantly, to understand these healing mechanisms.
@Joseph
Now you are sounding more reasonable, What you neglect is that, in the case of acupuncture, the “painstaking scientific research” that you rightly want has mostly been done. The result of that research is that “real” acupuncture is no better than sham and that the the advantage of either real or sham over no acupuncture is at best small and transient. You really should read Bausell’s book because he was involved directly in some of that research.
The root of my objection is that there is no point in looking at mechanisms until you are sure that there is something there to explain.
“It’s odd that reviews in CAM journals seem to come to quite different conclusions from those in the rest of the medical literature, Nothing to do with the fact that many authors in CAM journals are making a living from it, I hope.”
Possibly something to do with the peer-review process.
@DC
I think it is important to make a distinction between basic science research into acupuncture and clinical trials of acupuncture therapy.
The former demonstrates physiological responses within the nervous system to needle stimulation, e.g. release of enkephalins, β-endorphins, and endomorphins. fMRI show cortical and hypothalamus changes in response to needles being stuck in sensitive areas of the body (such as in the first interosseus muscles of the hand)
All very well and good, but clinical trials on the other hand fail to demonstrate significant clinical benefit from acupuncture therapy.
This is a good example of basic science research being irrelevant in the real world when treatments cost tax-payers money.
P.S. I find many post-graduate physiotherapy courses label themselves as ‘evidence-based’, but in reality what they do is employ a fair amount of reasonable basic science data and extrapolate this into clinical theory whilst conveniently ignoring the fact that clinical trials fail time and again to show clinical benefit (e.g. Pulsed Short Wave Therapy).
@ David Colquhoun
Distinguishing between ‘sham acupuncture’ and ‘real acupuncture’ is a very contentious issue, for a number of reasons. There is no consensus about what constitutes ‘real acupuncture’, and in practice, one person’s ‘real acupuncture’ is another person’s ‘bad quality acupuncture’ that doesn’t represent good clinical practice. The issue of whether or not ‘sham acupuncture’ is a valid control is also controversial, because ‘sham acupuncture’ produces real physiological effects which aren’t understood. In short, clinical research into acupuncture is currently much less satisfactory scientifically than clinical research into pharmaceutical drugs, for which the drug being tested is fully known, and the control is fully understood.
In his article ‘The Pros and Cons of Sham Acupuncture’ in EJOM Vol.6 No.4, 2010, Mike Cummings points out that ‘acupuncture’ is defined differently in different clinical trials. He provides 3 definitions:
Cummings goes on to observe:
To anyone who has considered research into acupuncture in depth, and who has a professional knowledge of acupuncture (which many evaluators of acupuncture research don’t), it becomes apparent that clinical research which has been done is extremely inconsistent in such basic issues as what is meant by ‘acupuncture’, and what is meant by ‘sham acupuncture’. I personally don’t think we’re anywhere near to having evaluated acupuncture via clinical trials in a manner that is even slightly satisfactory. There hasn’t even been any consistency in using traditional Chinese concepts. Basically, what we have is a rather inchoate profusion of results, which are completely unsatisfactory from a rigorous scientific standpoint.
However, within that, there is still reasonable evidence to show that acupuncture works, as Bovey’s compendium of recent systematic reviews shows.
I note that portions of my message immediately above, which was pasted from Word, do not appear. I’ll ask David Colquhoun to remove that message, and this one, and I’ll try posting the full message again.
@ David Colquhoun
Distinguishing between ‘sham acupuncture’ and ‘real acupuncture’ is a very contentious issue, for a number of reasons. There is no consensus about what constitutes ‘real acupuncture’, and in practice, one person’s ‘real acupuncture’ is another person’s ‘bad quality acupuncture’ that doesn’t represent good clinical practice. The issue of whether or not ‘sham acupuncture’ is a valid control is also controversial, because ‘sham acupuncture’ produces real physiological effects which aren’t understood. In short, clinical research into acupuncture is currently much less satisfactory scientifically than clinical research into pharmaceutical drugs, for which the drug being tested is fully known, and the control is fully understood.
In his article ‘The Pros and Cons of Sham Acupuncture’ in EJOM Vol.6 No.4, 2010, Mike Cummings points out that ‘acupuncture’ is defined differently in different clinical trials. He provides 3 definitions:
“Insertion of a solid needle into precisely defined anatomical locations in the human body for disease prevention, therapy or maintenance of health.
“Insertion of a solid needle into precisely defined anatomical locations in the human body, determined using traditional Chinese concepts, for disease prevention, therapy or maintenance of health.
“Insertion of a solid needle into precisely defined anatomical locations in the human body, determined using traditional Chinese concepts, for disease prevention, therapy or maintenance of health, within the context of a therapeutic encounter that includes the practitioner’s intention to heal and the patient’s expectation of recovery. “
Cummings goes on to observe:
“This variety of definitions means that to answer any research question formulated that includes the term ‘acupuncture’ may need a substantially different trial design depending on the definition used. Unfortunately, the term ‘acupuncture’ is rarely defined in reports of clinical trials and the reader must interpolate the definition used from the methods section of the report.”
To anyone who has considered research into acupuncture in depth, and who has a professional knowledge of acupuncture (which many evaluators of acupuncture research don’t), it becomes apparent that clinical research which has been done is extremely inconsistent in such basis issues as what is meant by ‘acupuncture’, and what is meant by ‘sham acupuncture’. I personally don’t think we’re anywhere near to having evaluated acupuncture via clinical trials in a manner that is even slightly satisfactory. There hasn’t even been any consistency in using traditional Chinese concepts. Basically, what we have is a rather inchoate profusion of results, which are completely unsatisfactory from a rigorous scientific standpoint.
However, within that, there is still reasonable evidence to show that acupuncture works, as Bovey’s compendium of recent systematic reviews shows.
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