Acupuncture infiltrates the University of Maryland and NEJM

This is embarrassing. In a recent article in the New England Journal of Medicine, Brian Berman from the University of Maryland argues why acupuncture should be recommended for patients with lower back pain. In the very same article he and his colleagues explain that the evidence shows that there is no difference between real acupuncture and sham acupuncture. That’s right: it doesn’t matter where you place the needles, or even if you puncture the skin. Even toothpicks will give the same effect. Any good scientist would conclude, obviously, that acupuncture doesn’t work.

But not Dr. Berman. Or (to give proper credit) his co-authors, Drs. Langevin, Witt, and Dubner.

Without a hint of irony, Berman and colleagues describe how

“Internal disharmony is believed to cause blockage of the body’s vital energy, known as qi, which flows along 12 primary and 8 secondary meridians. Blockage of qi is thought to be manifested as tenderness on palpation. The insertion of acupuncture needles at specific points along the meridians is supposed to restore the proper flow of qi.”

Note the careful wording: they write “is believed to cause” and “is supposed to restore.” Perhaps they don’t believe it themselves? Maybe they’ll explain later that this pre-scientific magical thinking has no place in modern medicine, and no basis in biology, physiology, physics, or any other science.

Nope! Instead, they say

“Efforts have been made to characterize the effects of acupuncture in terms of the established principles of medical physiology on which Western medicine is based. These efforts remain inconclusive, for several reasons.”

How about this reason: there’s no effect, therefore nothing to explain. Perhaps Berman missed that first-year course in logic.

Let’s be clear: acupuncture is pseudoscience. It’s based on magical thinking about a non-existent “life force” that has never had one whit of evidence to support it. The only benefits are placebo effects, as the sham acupuncture experiments demonstrate. The notion of “meridians” that can be somehow fixed by sticking needles into the skin is laughable. (A 2000 review article concluded that meridians and acupuncture points simply don’t exist.) Berman’s article attempts to give acupuncture credibility by pointing to studies that show, for example,

“Acupuncture has been shown to induce the release of endogenous opioids in brain-stem, subcortical, and limbic structures.”

Without getting into the details (most of these studies are poorly done), it’s no surprise that sticking needles into the skin causes a physiological effect. Duh!

Berman has gone to great lengths to try to show that acupuncture works. One of the studies he cites is his own NIH-funded study of “electroacupuncture”, a treatment that involves sticking in needles and then applying an electrical current. (One wonders how the “ancient” Chinese acupuncturists managed to plug in their needles.) To demonstrate that electroacupuncture releases hormones, they tortured some rats – nearly electrocuted them, in fact. To quote from the study:

“EA [electroacupuncture] intensity was adjusted slowly over the period of approximately 2 min to the designated level of 3 mA, which is the maximum EA current intensity that a conscious animal can tolerate. Mild muscle twitching was observed.”

But hey, what’s wrong with a bit of rat torture in the name of pseudoscience?

Why do I say this is embarrassing? Well, I’m a professor at the University of Maryland. I’m not at the the School of Medicine (where Berman is), which is an independent campus in Baltimore, quite distinct from the much larger main campus in College Park, where I work. But when the headline says “University of Maryland”, it reflects on all of us. And while I can’t prevent Dr. Berman from promoting pseudoscience, at least I can make it clear that he’s not speaking for me.

Dr. Berman is the recipient of millions of dollars in grants from NIH’s National Center for Complementary and Alternative Medicine (NCCAM) (here's one). It’s no surprise, then, that Berman concludes his NEJM article by calling for more research into acupuncture:

“It may also be important to try to identify the optimal candidate for acupuncture on the basis of individual beliefs, expectations, and psychological profile.”

In other words, let’s see if particularly gullible people might be more willing to tell us that acupuncture works. He recommends other studies too, presumably to be funded by NCCAM. Berman’s work is an example of why I have repeatedly called on Congress and the President to eliminate NCCAM. NCCAM’s annual budget of $129 million is an appalling waste, and after >15 years and >$2 billion in funding, it has yet to prove the efficacy of a single “alternative” treatment.

After reviewing the research and acknowledging out that sham acupuncture is just as effective as “real” acupuncture, Berman and colleagues recommend how to treat a hypothetical patient with chronic lower back pain:

“We would suggest a course of 10 to 12 treatments over a period of 8 weeks from a licensed acupuncturist or a physician trained in medical acupuncture.”

This is astonishing: they just finished explaining that acupuncture doesn’t work any better than sham treatment. So why go to a “licensed” acupuncturist, since you can use toothpicks that don’t puncture the skin and get the same effect? Toothpick acupuncture won’t cost $125 per session (that’s $1000 for Berman’s recommended treatment), and it doesn’t carry the very real risk of infection. Based on the evidence reviewed in their own article, Berman et al. are recommending a treatment that seems to border on malpractice.

I hasten to add that the University of Maryland at Baltimore (not my campus!) has many outstanding scientists and excellent research programs. But UMB seems happy to support this rotten apple in its midst (as does NEJM, I should add). It issued a press release about Berman’s article in which Albert Reece, Dean of the medical school, says

“Dr. Berman and his team at the University of Maryland Center for Integrative Medicine are international leaders in the field of integrative medicine; they are among the many innovative, world-class researchers at the University of Maryland School of Medicine.”

I’m afraid I’ll have to disagree with the Dean on that. Berman's Center for Integrative Medicine is an embarrassment to the University, and its presence undermines the efforts of other scientist to understand and treat disease.

But hey, maybe I’m missing something. Perhaps I just have a blockage in my qi.

(For further reading, I highly recommend the excellent blog posts on the Berman et al. study by Mark Crislip, David Gorski, and Steven Novella, all at Science-Based Medicine.)

Scientists build a better salmon

Salmon may soon be the first genetically modified animal to hit our dinner plates. We've been eating GMO foods for years, mostly without noticing it, but until now all the genetically modified organisms have been plants.

The new salmon was developed by AquaBounty Technologies, a company in Massachusetts, and here╒s how it works: start with Atlantic salmon, add a growth gene from the Pacific Chinook salmon, and add another gene from the ocean pout (Trisopterus luscus). In combination, these two genes make the Atlantic salmon grow to maturity in just 18 months, instead of the normal 3 years. The new salmon have the potential to make salmon farming much more efficient. The Washington Post reported this week that the FDA is close to approving the fish for human consumption.

This is cool science. So why are all the reports, both in the mainstream media and the blogosphere, making it sound like a frightening development?

Let's get one thing straight: we have to learn how to farm our fish. The human race is rapidly depleting the stocks of almost every wild fish that we like to eat, and many traditional fisheries are already wiped out. Others have been depleted so badly that severe fishing limitations have been imposed in a desperate attempt to allow stocks to recover. This can't go on.

Think about it: we farm all the other animals that we eat. Imagine that we only ate wild cows, or chicken, or pigs. The human race can't be fed by wild animals alone - we're too numerous and too hungry. Sooner or later, we will drive wild fish to extinction, unless we make the switch to farmed fish.

And as I wrote recently, oily fish like salmon contain omega-3 fatty acids, which appear to carry health benefits, especially when compared to the fats contained in other meats. We should all eat more salmon.

Okay, but what about the downsides of GMO salmon? The anti-GMO forces have issued statements warning of dire consequences if these "Frankenfish" are allowed on the market. Wenonah Hauter, the director of Food and Water Watch, a nonprofit whose goals I generally support, issued a statement that is full of misinformation. For example, she claims that the salmon are "toxic", which sounds pretty scary. As evidence, she says "a recent study commissioned by the European Union revealed that fish that have been modified to grow faster also have a higher tolerance to the toxins in their environment."

I looked up the EU study, by by Fredrik Sundström at the University of Gothenburg, to learn what it actually said. Although the university's press release says that "transgenic fish can be more resistant to environmental toxins," the study itself didn't provide any evidence for this claim. In fact, it didn't even study toxins. Instead, Prof. Sundström looked at what might happen if GMO fish escaped into the wild, and he concluded that they might survive better than wild fish. He didn't conclude anything about toxins.

Hauter of Food and Water Watch isn't the only one to get this wrong. Reporter Paulina Reso at the New York Daily News got it just as wrong, reporting that "A study commissioned by the E.U. found that these engineered fish have a higher tolerance to toxins, putting consumers at risk." She cites the same press release from the University of Gothenburg.

Not only is the claim about toxins unfounded, but it ignores the very real (and widely documented) danger of mercury accumulating in wild fish, including salmon. If you're truly concerned about toxins in fish, you would support fish farming, not oppose it.

The Center for Food Safety's George Kimbrell, quoted in The Post article and elsewhere, threatened to sue the FDA if they approve the new transgenic salmon. He says they are concerned about "catastrophic consequences like the gulf oil spill." Wow, that sounds awful! Transgenic salmon will be as bad as the largest oil spill in U.S. history? Is he kidding? Rather than spend time on breathless hyperbole, Kimbrell should be worried about the very real possibility of driving wild salmon to extinction. He doesn't explain what his concern is based on, and it seems that his group simply opposes any genetically modified organisms on principal. Their opposition is not based on science, nor on any well-thought-out concern about nature or the environment.

And yes, I know that fish farming itself can be harmful to the local environment. But our response can't be to abandon fish farming and continue overfishing until all wild fish are extinct. As the saying goes, don't let the perfect be the enemy of the good. We should work on ways to improve fish farming techniques and make them more sustainable.

Transgenic technology is cool. Of course it can be used in ways that don't benefit consumers - but so can traditional genetic techniques (which don't require any FDA approval, by the way). Take tomatoes: I can't remember the last time I found a tasty store-bought tomato in the U.S. They look great but taste like cardboard, all thanks to selective breeding that makes them easier to pack and transport. If someone creates a transgenic tomato that tastes good, I'll be the first in line to buy it. Meanwhile, I'm looking forward to the day when I can taste the new transgenic salmon.