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| Moxibustion at work. |
In real science, we agonize over every detail. When we publish a paper, we strive to get everything just right. We qualify our findings, always allowing for the possibility that we might have missed something.
Oh, to be freed of the constraints of reality. But fiction, alas, doesn't work in the real world. Fantasy medicine is, well, a fantasy. Or is it? Let's enter the world of Complementary and Alternative Medicine.
Imagine a scientific journal in which every single article was wrong. Not just an occasional mistake, as happens with many journals. No, I'm talking about a publication where every single article has at least one fundamental flaw.
No, it's a real journal, published by BMJ, the publishers of the well-known journal by the same name (the British Medical Journal). "Helping doctors make better decisions since 1840", they proclaim. Then why, among their 40+ journals, do they publish Acupuncture in Medicine?
It appears - I can't prove this, but it seems to be so - that every single article in this journal is wrong. Not just a little bit wrong, either. Let's look at the "Editor's choice" article from the latest issue, which must be one of their best. It's called "Using moxibustion in primary healthcare to correct non-vertex presentation: a multicentre randomised controlled trial".
In this study, a group of Spanish doctors looked at the use of moxibustion to correct a common problem in pregnancy known as a breech position - that's a baby that is turned the wrong way round in the mother, head up instead of down. What, you may ask, is moxibustion? Well, let me use the authors' explanation:
"The application of heat from the combustion of Artemisia vulgaris (moxibustion) for therapeutic purposes has long been used in China. Among other effects, it is believed to contribute to correcting the non-vertex presentation of the fetus when applied at a specific acupuncture point (BL67 Zhiyin) located at the outer corner of the little toenail."That's right: you burn an herb (Artemisia) next to the little toenail of the pregnant mother, right next to an acupuncture point, and that's supposed to make baby flip right around so its head comes out first.
You can't make this stuff up.
These guys are serious. They ran a study where they divided pregnant women into 3 groups, with about 135 women in each. One group got moxibustion, another got "fake" moxibustion, where they burned the herb next to a different toe (really!), and the last group got standard care.
Amazingly, the doctors found that it works! More of the women with moxibustion had babies born the right way round, head down, than in either of the other two groups. To be precise, 79 babies in the moxibustion group came out the right way, versus 60 and 59 in the other two. By the authors' own analysis, this difference was statistically significant.
Wow. Maybe this stuff really does work. And moxibustion is cheap and easy to administer. Maybe this is the solution to our rising health care costs.
How to explain this result? I see several possibilities:
- The small effect was just a random variation, not due to the treatment. Previous studies of exactly the same treatment (such as this one) showed that moxibustion did not work. So either those studies are wrong, or this one is.
- There was bias in how the women were assigned to treatment, and the effect can be explained by that.
- The authors manipulated the data to make the numbers come out better. (Quelle surprise! Not in a BMJ journal!) Of course we can't prove this without much more investigation.
- Burning an herb next to the little toe at just the right place - and nowhere else - stimulates a mystical "qi" pathway, and zaps that little baby back around the way he's supposed to be.
OK, I admit it: I haven't read every single article in BMJ's acupuncture journal. So I don't really know that they are all wrong. But who has time to read all this bad science? The latest issue has a disturbing number of articles about acupuncture for cancer, which I find particularly upsetting because that practice takes advantage of highly vulnerable patients. It also includes an article on ear acupuncture, a practice invented out of whole cloth by an Army doctor in the U.S., who has been inflicting it on injured service members, as I've written about before.
Actually there is one article that seems plausible. It reports a case of arterial hemorrhage caused by an acupuncture needle. But we don't need to dwell on that.
Acupuncture in Medicine has all the trappings of a real journal, including an editorial board whose members work at respectable medical schools. I know that BMJ wants us to believe it; after all, they make money on this stuff. As for the journal itself: I can't bear to read any more. It is just too painful. Perhaps acupuncture would help.
I wish you had given more detail in critiquing the "study". Superficially, to my idiot altie friends, this looks great! Way more women had babies in the correct position after the "treatment", they will say. I don't think they'll be impressed by the factors you list without further detail.
ReplyDeleteWhat's with the BMJ anyway--is anyone in Britain complaining?
Janet: thanks for the comment - I would have given more detail, but I'm afraid the study doesn't really have enough detail itself to figure out where the experimental bias crept in. A rigorous reviewer would have insisted on much more of such detail, but Acupuncture in Medicine doesn't seem to have such reviewers (not surprisingly). So from what they say in the paper, it does look like moxibustion worked. In a real peer-reviewed journal, they'd have never gotten away with this. That's the danger of having BMJ publish a pseudoscience journal that has all the trappings of real science.
DeleteYou say "they'd never have gotten away with it" as if no allegedly "real" science was ever published without being reproduced (because really, reproducibility is what you're addressing here. Researchers can and should research whatever they choose without anyone stopping them; we just have to look at all the other studies of the same kind and see how those fared.) Research is published every day in respected medical journals that are one-hit wonders, if you will. Not reproducable or nobody has bothered to try. These happen to be the ones picked up by the media and circulate as being fact because, well, it's a "study" and to the lay man, that magical term somehow means infallible, solid, never-changing fact. Those of us in science and research understand that this is not how science works (riiiiight?), so we take studies of this nature with a grain of salt.
ReplyDeleteI'm curious as to what you're after here. The BMJ to stop publishing Acupuncture in Medicine? For readers/practitioners to boycott the BMJ until they fall in line with your ideal of science? That the scientific community stop regarding certain health care practitioners (accupuncturists, chiropractors, and homeopaths) as legitimate practitioners? A scaling back of research topics themselves/not allowing studies to be performed when the topic involves something that Western cultures writes off as being nonsense? It continually baffles me to hear other science-minded people so up in arms and using the term "pseudoscience" simply because they cannot understand the value of the topic. Science is open-ended. Test a theory, get results, tweak theory, test again, and so on. The entire point of science is to gather data. And even "failed" theories are valuable to a good scientist because that's where we figure out what works and what doesn't. That very process itself is WHAT science even is! We should not seek to place our subjective limits on science. Just because I may not see the value in studying X, doesn't mean that it isn't important, that there's nothing to be gained by studying it, or that it isn't valuable to someone!
As a side note, I have personal experience with moxibustion. Nearing week 38 of gestation, I was becoming disconcerted by my baby's transverse position. There are many methods that can be attempted to turn a baby vertex, and I did some handstands and hanging off furniture in awkward positions to try to get baby to turn vertex. Physicians use ECV (external cephalic version) to turn a baby, which is quite painful for the mother. When reading about moxibustion, I thought "What could it hurt?" So we tried indirect moxibustion. This is purely anecdotal, of course, and could have more to do with many other factors, but within two days of trying moxibustion, baby was vertex. Western culture recognizes mugwort for its action on circulation (ancient Eastern cultures say "changes the balance of yin-yang energy of the blood,") and that increased circulation to the uterus can cause contractions, aiding in fetal position change. Right or wrong (and we don't know, because not enough research has been done on it, period,) moxibustion - as most Westerners use it - is harmless, kind of fun, and interesting.