Astana used acupuncture

That is definitely hokum...

Bike forums, hey?

Again, thank you for a comprehensive response, I've skimmed the seemingly big points but will revisit when im not having a few beers before doing a gig.

As I said, I have no agenda, I may have appeared confrontational in a devils advocate way but I am genuinely open to being proved wrong. I find being proved wrong and told why is the best way of learning more.

I'll probably come back with more mithering in the future if thats ok?

I think its fair to say that for most non academics, and even quite a few academics if Im honest, don't actually how to read the information, rather than saying they don't understand the information if that makes sense, I know many 'lay people' that have a better grasp on the meta process than some very clever Ph.D's

Take the word theory as the best example, to most people a theory means an opinion, so the Big bang, Evolution, Relativity all theories. The most used and most incorrect response to Evolution is its just a theory, that does not make it true, but the actual definition of theory is an explanatory framework for some observation. So if I do an experiment on my bike (this is a bike forum) I ride on the turbo trainer for 30 min rest, repeat, rest repeat....measure my heart rate, blood pressure speed cadence or what ever, get all the data, these are observations, if I repeat this over several days or weeks, and can take all the information, I then have my theory to roughly know what my results will be next time because of the data and proof that I already have.

Or I can hypothesise that by having some treatment or taking a supplement having a needle with or with out EPO etcetera that this will increase my output by 50%.

Nearly everyone will call this part a theory rather than a hypothesise....so Theory is an explanation of the observations, not a good guess based on what we think we know.

So in the research world, especially when it comes to meta analysis or systematic reviews, you may well see what looks at face value positive results, so for the neck pain it does look like it works, and the review panel can only say that the information provided indicates positive results as they only have that information to deal with, they cant say it was faked or false, but what they have done in this instance is used the JS to (not) say that the results are positive, however there are flaws in the trials that (probably) would alter the results if the flaws were not present.

Unfortunately as the information is presented in such a way, non academics will use the abstract of a review to show that something does work, Homeopaths are the best for this, but to be fair to them I really doubt they understand the information they are posting, they just see positive results and think its all good.

You really don't need to spend a lot of time reading the full reviews, if I see inconclusive on a Cochrane report, I wont look to deep unless im looking for a specific claim. Something else thats interesting is that when looking at CAM treatments its quite common to see a comment such as "more detailed or further trails required" or "more independent data required". This is normally because the people doing the trails are not really qualified to do so, or if they are, do not have ethics committees supporting them, so its uncommon for the reviews to say flat out that there is no evidence that this treatment does not work, typically as there is little supporting evidence. However this nearly never happens when you look at reviews for modern medical procedures, a search for cancer is a good example of this as its probably the most studied disease/condition.

Finally, I don't like the term lay person as it makes out that a non lay person is superior, I know a bit about science, but I now next to nothing about plumbing, when my toilet is backflowing, the plumber is the smartest person I know, the reason that the reviews are contradictory and inconclusive, is that the are contradictory and inconclusive, none are positive or statistically significant.

Finally Finally, you dont need to be an academic to understand how it works, Read Bad Science and Bad Pharma (this goes deeper into systematic reviews) but have a read of http://www.sciencebasedmedicine.org/ or http://theness.com/neurologicablog/ they tend to pull apart bad research and explan how/why they are doing it

Quite a comprehensive response, so thank you for that.

what you're saying is its my lack of knowledge or understanding when reading these reviews that is holding me back? Thats is not a trick question by I'm the way, I'm genuinely willing to hold my hands up and admit ignorance.

Reading through the reviews, and im far from reading all of them, it seems to me to be contradictory and inconclusive, is that simply just down to me being a lay person as it were?

Again, yes I have read them all, but thanks far asking for the clarification, if you are interested I have also read over 600 reviews of Homeopathy and about the same on TCM...

You are saying that you have no agenda, but you asked for

Quote:

Farrell wrote:
I am more willing to be proved wrong and hold my hands up to it just being a placebo effect if you can point me in the direction of such evidence?

So I posted a link to the most respected repository of the information you asked for, I did not say at any time that this was information only on back pain, it is however a brilliant start point for evidence on the efficacy of acupuncture, I could have sifted through them, or I could have posted 100's of other links that have similar information, but I am sure you would have come back with the same response, without reading the information provided any way. So you asked for the information, I provided it, you did not read it, rather you looked for some information that you though may have helped prove your point.

I have read the review on the neck pain, as I said, I have read them all, what you will find is most of the reviews do go along a similar line, they will either out and out disprove the research or say at best, as it has on the neck pain

Quote:

The trials were of moderate methodological quality

the number of participants in each trial was relatively low

so we could not combine the results of the trials to get an overall picture

However, a large proportion of the reviews will state along the lines of

Quote:

Further methodologically robust studies are needed to generate evidence-based conclusions.
There is no reliable proof of effectiveness of xxxxx for xxxx due to lack of randomised controlled trials up to now.

these are red flags straight away, I am looking for the words Statistically significant, not moderate. why? well If I were trying to get a drug to market and the results were moderate, I would not get approval at all, so why would you want to use a lower standard for any treatment.

Back to the neck review, it says

Quote:

We did not find any trials that examined the effects of acupuncture for acute or subacute pain, but we found 10 trials that examined acupuncture treatments for chronic neck pain. Overall, methodological quality had a mean of 2.3/5 on the Jadad Scale.

Unfortunately not a lot of people understand this last part, anything under a JS of 3 is considered to be a low quality trial, generally as its not been correctly blinded or randomised, and importantly, the drop out rate, if the drop out rate is high, the trail needs to be completely ignored as pts will drop out of they don't feel better, so if 100 people start, 50 drop out because they are getting worse or not seeing improvement, and out of the 50 that stay, 25 report vast improvement but the other dont, the result will incorrectly show as 50% showed improvement as the pts that drop out do not measure in the end result, I havent looked at the drop out rate for this review as it is not really significant given the JS score, unfortunately they do not always use a JS,.

Back to the review

Quote:

Authors' conclusions:
There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.

You need to pay attention to the term moderate evidence, under the Cochrane guidelines this means

Quote:

Moderate evidence denoted findings in a single, high quality RCT or consistent findings in multiple low-quality trials.

being that there is a review of 10 trials, there is a fair assumption that this score is given due to consistent findings in low quality trails (low JS scores)

So let me ask you this, if I offered you a treatment that I have proven with 10 trails, but the trials were of poor quality, there was a high proportion of drop outs, blinding and randomisation was in question, but the results I publish are ok...would you actually pay me for the treatment?

either way, you asked for proof, and I have provided not only the resource, but now a very brief introduction on how to understand and rate the results of the reviews, if you take the oppertunity to read through these reviews, and happen to come upon a Meta anaysis with a >4 JS or one with Strong evidence under the Cochrane Qualitative Analysis of Trial criteria, I would be more than happy to discuss

if you want to know if its harmless or not, have a look at this http://whatstheharm.net/acupuncture.html and its true people do have reactions to medication also, but medication is studied and reviewed, doctors have regulatory authorities and bodies that keep them (or try to) in line, CAM practitioners do not

Also, someone mentioned a good point about Drug pushing Omega-Pharma Quickstep stooges, yes there are many of them, to many and I know quite a few personally that don't have any moral issues with taking "loyalty" from drug companies, and a few that lend there qualifications to the Big Pharma in return for , well anything from research money to cushy jobs, but whats important to remember, the people carrying out the meta analysis are not are generally employed by a research institute they get nothing more if the results are positive or negative.

The busiest and most requested GP at my surgery before he left was a family man with who felt there is a place for complementary therapies alongside pills and potions.

My parents' GP, who recently retired from running his NHS practice, used acupuncture where he felt it would help. He too would prescribe all the usual drugs that doctors dish out.

For each of these trained and very experienced professionals you can decide if he is:
1. a ' real' doctor (whatever you think that is)
2. a drug-pushing stooge paid to boost Omega Pharma's vast profits, or
3. a self-appointed guru or quack selling snake-oil to gullible celebrities.

Tony Martin was wearing kinesiology tape during the Tour, not the first time, I believe. I know the sports therapist that works with the Atherton siblings in the GT racing team and he uses kinesio tape on the athletes. I don't know how (or whether) it works as claimed but these professional athletes are still winning races at the highest level so I remain open-minded. I will quiz him next time we meet.

However, I always felt that Power Balance bands, as worn by numerous athletes, are a complete ripoff.

I want my magic anti-bear rocks.

For a couple of years I had regular acupuncture sessions followed up with a massage to help release tension in my shoulders and back. It was cheap, low-risk and I always felt much better afterwards - I wouldn't have continued so long had I not. I really don't care in the slightest if the benefits were physical or just psychological. Why would I? All the folks on a desperate crusade to point out that it's all bunk are missing the point that the man who just won the TdF (what races have YOU won btw?) is also receiving some benefit and nobody is forcing you to have pins shoved in you so what's the big f%#king deal?

I have some protection rocks for sale for £20 that I guarantee with keep you safe from wild North American Brown Bears, but you must keep it on your pocket at all times, and never take it out of the UK as the chi in other regions is not powerful enough to trigger the anti North American Brown Bear defence aura

If at any time you are attacked and killed by a North American Brown Bear in the UK I will happily refund your £20

Firstly, there have been many studies that have proven something, that have later been disproved or found to be fraudulent, the best so far is the MMR study by Dr Andrew Wakefield, as a result of this study it is approximated that over 100,000 children have dies as a result of not being vaccinated, and millions have suffered from conditions that were easily prevented.

Secondly, the 2009 study is contentious as the control results were quite high and close enough to the acupuncture results that it was concluded that where the needles were placed may not be relevant, however acupuncture is based on needles being placed in certain areas to achieve a result.

Thirdly, the Cochrane meta analysis of acupuncture shows overwhelmingly that acupuncture does not work, if you are unaware of what a Cochrane review is, I suggest you find out, in basic terms, this is the go-to organisation for medical research and data analysis.

Fourthly, I have suffered for 20 years with chronic back pain as well as sever pain in most of my joints as a result of doing silly things like joining the Army and getting blown up and shot at a lot, I also have lots of tattoos. If you consider getting a tattoo is the equivalent of getting acupuncture at a gamma scale, not only should I never feel pain again, neither should the next 10 generations of my offspring.

Finally, as much as the placebo effect is real and largely not understood, you must remember that people get better, there are several quality studies that even show the color of a tablet increases the perceived response from a patient, but this is all self reported, there are no studies that show a placebo response to anything that can be measured by an isolated observer or by instrumentation, for instance a broken bone or open wound, so it is clear that the placebo response is controlled in the brain, not at the location of the injury or pain.

Finally-Finally, that attitude of "well whatever works" is a pile of crap, as I have said, the placebo effect is real, and is the corner stone of Alternative Therapy. The bigger problem is when celebreties or high end sports people use such treatments, the general pubic take this as an endorsement and end up wasting there hard earned cash on treatment that does not work, or works just as well as mind over matter, have a look back over the past few years, and especially the past 2 Olympic Games with the use of Kinesiology Tape which as been proven time and time again to do absolutely nothing, however more and more people are using it.

I remember a Chinese Acupuncture doctor from France. She felt my wife's pulse and told her that she was pregnant, and indeed she was (she wasn't showing any visible signs of being pregnant at that time).
In Chinese medicine the pulse is measured in a different way, not just bpm. I was at the clinic to be treated not my wife at that time, the doctor was just being friendly.

In martial arts, methods were developed to target certain areas of the body with certain force. Knowledge of human body mechanics and manipulation of nerve function and blood flow. Just as acupuncture does but for beneficial function. Not really complicated, if you have the knowledge.

In essence, learn to cure first before you learn to harm. That is much harder.

That's all for today

Al_S appears to be under the impression that therapies such as Acupuncture are like religious belief in the Middle Ages and based on nothing but hearsay. Unfortunately this view - that because it hasn't been "proven" in a lab by men in white coats then it must therefore be bollocks - is pretty weak at best.

Firstly, let's not forget that science never has all the answers. Just because we do not know whether or how something works does not mean it doesn't work.

Secondly, there are lots of people for whom these things genuinely work. I know a number of people who have experienced real changes in their health after treatments; I'm not talking about the blind being able to see or a lame man walking but real change for which the beneficiary/patient/client is profoundly happy. These people are not necessarily 'seekers', the kind looking for a kind of quasi-religious or vaguely spiritual answer willing to believe some hokum.

Placebo is a long acknowledged phenomenon, it does not prove or disprove anything. Would you prefer someone to continue to live with pain/distress simply because the treatment is "only placebo"? And how do you know it's solely placebo? Placebo (and Nocebo) can be useful, regardless of context, and to dismiss it as the patient somehow kidding themselves is stupidly denying the incredible power of the mind.

I don't understand this absolute unshakeable belief in the magical ability of GPs and pharmaceuticals. Have you been brainwashed by the CEOs of Bayer et al? Drug companies exist to sell drugs, not to heal people. Statins. What a con! And the side-effects of powerful drugs; do you think they are universally a good thing? And don't get me started on why money for cancer research actually funds massive corporations so they then flog the stuff back to hospitals, even though lots of it doesn't work as it should.

Also, if you believe drugs can mend people, which they clearly can, is it not possible that other things can also effect change? Why can a pill or injection wrk but not anything else? Or do you have knowledge of human anatomy & physiology denied those at working in medical research?

While I have long been labelled a sceptic/cynic, I have the benefit of first hand experience and numerous accounts of 'weirdo' treatments, most notably reflexology. Being married to an highly intelligent, widely read complementary therapist (who also trained as a nurse in the NHS) has shown me that it is plain ignorant to dismiss such things with a closed mind. But if ignorance is your bag Al_S then feel free to ignore me and carry on...

@ronin: 2 points:

1) The plural of anecdote is not data. I once had a nasty cold that persisted for weeks - none of the normal treatments were working, so one night I decided to get smashed on whisky. The next morning, once my hangover cleared, my cold was completely cured! Clearly, this is objective and universal proof that getting smashed on whisky is a completely valid cure for the common cold!

2) We're not talking about Al_S' knowledge on the subject of acupuncture, we're talking about a scientific method that has been in gestation for thousands of years and demands that, for things to be accepted as objective truth, they should be measured against objective measures. That, along with a massive body of published and peer-reviewed studies generated using that method - that represents rather more knowledge than Al_S has to retain in his head for any length of time.

Despite the application of thousands of studies, using these methods, to acupuncture there is no consensus that it is any more effective as a treatment than taking a big red sugar pill or having someone in a white coat say "There, there, you'll feel better tomorrow". That's not to say it isn't effective (see my post above)...

For clarity, my acupuncture treatments came with no Eastern mystique, it was delivered by an NHS physiotherapist in clinical surroundings. So no soothing voices, very little to put you at ease and the only music was the occasional bass thud from a passing scrote mobile.

It was never a relaxed affair until I left feeling relaxed, at one session due to the appointments running over schedule I ended up sharing the treatment room with another patient who was a complete stranger whilst I lay there in my boxers.

I'm open minded enough to be proved wrong, I have no problem with being told it was all an effect of my mind, but I haven't seen enough to make me doubt acupuncture or to agree that it is quackery.

I wonder how much of the effect of conventional doping is placebo. The placebo effect is very powerful. If you think you've got a secret advantage over your competitors, then you've got an advantage. (I'm not talking about EPO or blood transfusions here. I'm thinking of other banned products which have a less marked effect.)

You go to the doctor, you sit waiting because their appointments are over running, you get hurried in, they listen to you and if it sounds like they can, they'll issue you a prescription and hurry you out. This will be a rather "clinical" situation.

You visit a quack, they'll have longer appointments, and will sit you down, relax you, maybe have soothing music etc.

(can't find the reference) the best acupuncture studies that have been done have had the patients split four ways. Half get their treatment in "traditional" acupuncture settings, half in a more clinical environment. Half get the needles stuck in the places that the acupuncturists say they should be, half get them stuck in arbitrary places.

If acupuncture had any effect beyond placebo (which can be beneficial, but there's ethical issues about giving someone a treatment which you tell them works but you know has- and can't have- any scientific basis) then the groups getting "real" acupuncture, both in the relaxed and clinical settings, would see a benefit. But what is found is that those in the relaxed setting, be it "real" or "sham" acupuncture, get a benefit. Which is interesting as far as considering how treatment rooms should be designed and run, but that's another matter.

This idea that "traditional Chinese medicine" and similar has some sort of validity because it uses ideas that have been around for "thousands" of years is utter toss. Modern medicine uses ideas that have been around for thousands of years, just refined, researched and put under proper scrutiny. We've ditched lots of ideas that had been around for a long time because they were wrong- the idea of "bile", the idea that the heart does any sort of thinking, and so on.

Apologies if this is tl;dr - if it is, well, tl;dr!

Actually, placebo is a very effective treatment. I can't recall the paper off the top of my head (it was a published, peer-reviewed study and I will dig it out if anyone is interested) but patients given a pill *and told it was a placebo* showed a measurable improvement in a variety of pathologies. Interestingly, if I remember the contents correctly, the most effective placebo pills were large red or yellow ones.

Doctors can be effective placebos too - again, I'll dig out the study if anyone is interested, but a doctor saying "You'll be better in no time" has much better outcomes than a doctor who says "I'm not sure this treatment will work for you".

My understanding is that acupuncture has inconsistent results in evidence-based testing, partly because of the difficulty in designing experiments with a control group for such an invasive procedure. Chiropracty and osteopathy are theoretically junk, but have some good results for musculo-skeletal pain.

Essentially, it may well be that any team could get the same results as Astana by employing someone that the riders trust as a professional to give them a big red sugar pill and tell them they're definitely going to win! It will work brilliantly until the other teams uncover it as a method!

If acupuncture was the only thing I'll be delighted... It's doesn't work beyond placebo as recently demonstrated in this study http://www.badscience.net/2007/09/acupuncture-and-back-pain-some-interes... where "needles stuck anywhere with a bit of ceremony" was contrasted with "proper acupuncture" both worked... = placebo effect.

We know that placebo does actually help up to a point, but to my mind it isn't cheating.