|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.