Sadly, the Washington Post once again falls for acupuncture pseudoscience

It’s like playing whac-a-mole. No matter how many times I write a column showing that some wildly implausible practice is nonsense, new articles pop up claiming “Hey, look at this! It really works!”

So I’m going to try to whack another mole, because people can be harmed by bad information, especially when it comes in the form of medical advice.

Recently the Washington Post ran a column under the headline, “Does acupuncture work for chronic pain? Here’s what the science says.” (The column first appeared back in July, but the Post’s website promoted it again just last week.)

Before giving you the Post’s answer, let me give you the correct answer. No! Not “maybe” or “sometimes” or “we’re not sure.” Acupuncture doesn’t treat anything, and it carries a real risk of harm, particularly from infections. I’ll get to that below.

I’ve written on this topic many times before (in 2013, in 2012, in 2010, and more), and I’ve even called out the Washington Post for their pro-acupuncture pseudoscience (see this column, which I wrote in 2016). The physicians over at Science-Based Medicine have debunked more acupuncture studies than I can count; they’ve even created a special webpage (which I highly recommend) dedicated to explaining the bogus claims that acupuncture proponents make.

Acupuncture, in case you don’t know this, is a practice where people who call themselves acupuncturists (they are not doctors) stick needles into your body to “treat” various conditions. The claim is that these needles can manipulate your vital life force, or “qi”, which runs along supposed acupuncture lines throughout your body.

That’s just wrong. Modern biology has taught us a whole lot about human physiology, and there just aren’t any lines with mystical forces flowing through them. There are nerve fibers, true, but acupuncturists don’t use those. (And if their needles were piercing nerves, it would hurt like heck.)

Acupuncture and qi are part of Traditional Chinese Medicine, or TCM, a collection of largely ineffective and sometimes very harmful folk beliefs. TCM’s popularity started to grow in the mid-20th century when Chairman Mao launched a propaganda campaign pushing it. Mao himself never used TCM, but his government couldn’t afford real medicine, so they convinced people that inexpensive folk medicine was just as good. It wasn’t.

But I digress.

Acupuncturists claim to treat many conditions, but they especially like to claim that they can treat chronic pain, for at least a couple of reasons. First, pain is inherently subjective, so the only way to measure if a treatment is working is to ask the patient. This makes it hard to study objectively. And second, pain symptoms usually wax and wane, even without any treatment. Patients usually want treatment when the pain is at its worst, which means once the pain subsides, the patients will give credit to whatever they were doing at that time. So pain is fertile ground for people selling quack treatments.

Now let’s get to that column in the Washington Post. The column promises to tell you “what the science says,” and it quickly gets to the point, saying yes, it does! First it puts forward the logically flawed (and non-scientific) claim that hey, the U.S. Medicare system now covers acupuncture for back pain, so it must be effective.

Ugh, where do I start? Well, like it or not, Medicare approval of a treatment doesn’t mean the treatment works. (And conversely, some treatments that work are approved for coverage by Medicare.) So that’s just a logical fallacy. I wish it were true that Medicare was purely science-driven, but both the federal and state government have been lobbied for years by acupuncturists (and other purveyors of dubious therapies) to provide public tax dollars to cover their practices. For a deeper dive into these lobbying efforts, I recommend the lengthy takedown by Jann Bellamy explaining that acupuncture is “legalized quackery.”

The Post article then goes on to discuss the science, for which it relies primarily on a single study, a meta-analysis published in 2019 by Andrew Vickers. (The column was written by Dr. Trisha Pasricha, who has sterling credentials, including training at Johns Hopkins Medicine where I also work. Alas, good credentials don’t always mean that you can trust the holder of those credentials, and this is one of those instances.)

Vickers has published multiple meta-analyses, and if he’s shown anything, it’s how easy it is to cherry-pick from the (extensive) acupuncture literature and find studies that prove whatever point you want to make. The Post column asserts that Vickers used 39 “high-quality” studies, but that is debatable. Many of the studies were done in China, which (as Science-Based Medicine physicians David Gorksi and Steven Novella have pointed out) virtually never publishes a negative study of acupuncture.

I’ve done a deep dive into one of Vickers meta-analyses of acupuncture–an earlier one–for one of my medical school classes, where I use it to illustrate how bad studies can be mis-reported by scientists themselves and by the media. I don’t have time to go through it here, but among other problems, Vickers doesn’t seem to understand how placebo controls work.

Here’s what I mean by cherry-picking. Vickers went through 100’s of studies to pick the 39 that he included. One of those supposedly high-quality studies looked at acupuncture for knee arthritis. That study found that both acupuncture and sham acupuncture (the placebo arm) and the same small effect on knee pain, and that patients who received no treatment at all reported more pain than patients. The authors of the study (and Vickers) concluded–wrongly–that because acupuncture was better than nothing, it must be working. Wrong! If you don’t beat the placebo, then your treatment fails.

For a drug trial, failing to beat the placebo means the game is over. But with acupuncture, it means “more studies are needed,” and the whac-a-mole game continues.

Oh, and I should add that as far as knee arthritis goes, the reduction in pain in both the acupuncture and placebo group was much less than has been reported in studies that use ibuprofen.

That’s right, ibuprofen is far better than acupuncture. Not to mention cheaper and more convenient.

If this weren’t enough, a more recent study has already contradicted the Vickers study as physician-blogger Steven Novella pointed out in a recent column. Novella wrote that “the evidence is too low quality to conclude that acupuncture works, as desperate as proponents are to say we can reach that conclusion.” So no, Dr. Pasricha, the latest science does not say that acupuncture works. Quite the opposite.

I’m still understating how badly acupuncture has failed every well-designed study to test its effectiveness. Studies have shown that placing the needles in random locations works just as well as using so-called acupuncture points. Other studies showed that sham acupuncture, where the needles don’t pierce the skin but where subjects believe they did, also works just as well. And “expert” acupuncturists can’t agree on the locations of acupuncture points.

And don’t get me started on acupuncture and the risk of infection. Acupuncturists aren’t trained in real medicine, and they don’t use proper sterile procedures. This means that they don’t necessarily sterilize their hands, or your skin at all of those points where they’re plunging needles into you. There have been thousands reports of infections due to acupuncture (dating back decades), some of them fatal. And because acupuncturists aren’t part of the medical system, we can be virtually certain that infections are under-reported.

Acupuncture isn’t going away any time soon, because people are making money from it, and no matter how many studies show that it’s nothing more than a fiction, those people will keep insisting on more studies. Plus they can point to hundreds of poorly-done studies that claim to show benefits, and argue–as the Post column does too–that “more research is needed.” I’m not making this up: that precise phrase appears in Dr. Pasricha’s article.

There are even scientific journals entirely devoted to acupuncture (here and here, for example), and they make money too, for the for-profit publishers that produce them. So you can be sure that more studies are coming, and some of them will be positive, even though acupuncture is utterly ineffective.

Even so, the Washington Post can and should do better. Here’s my (free) advice for those considering acupuncture: save your money, and just take some ibuprofen.

Good news for "Research Parasites": NEJM takes it back, 8 years later

After years of debate, the National Institutes of Health finally rolled out a data sharing policy early this year, one that should greatly increase the amount of data that biomedical researchers share with the public. This week, three prominent scientists from Yale described, in an op-ed in the New England Journal of Medicine, how “the potential effects of this shift ... toward data sharing are profound.”

For some of us, it’s deliciously ironic that this op-ed appeared in NEJM, which just a few years ago coined the term “research parasites” to describe anyone who wants to make discoveries from someone else’s data. That earlier piece, written in 2016 by the NEJM’s chief editors, was simply dripping with disdain. It caused a huge outcry, including a response from me in these pages and a sharply worded response from the Retraction Watch team, published in Statnews. The editor backed down (slightly) in a follow-up letter just a few days later, but the damage was done.

One interesting consequence was that a group of scientists created a Research Parasite Award, now awarded each year (entirely seriously, despite the tongue-in-cheek name) at a major biomedical conference, for “rigorous secondary data analysis.”

The 2016 op-ed in NEJM was itself a response to a call for greater data sharing published in the New York Times by cardiologists Eric Topol and Harlan Krumholz–and Krumholz, we should note, is a co-author of the latest piece in NEJM. Meanwhile, the former editor of NEJM retired years ago, and it appears that the journal is now ready to join the 21st century, even if it’s a few decades late.

What is all this fuss about? Well, many people outside of the scientific research community probably don’t realize that vast amounts of data generated by publicly-funded research–work that is paid for by government grants–are not usually released to the public or to any other scientists.

On the contrary: in much of biomedical research, data sets collected with government funding are zealously kept private, often forever. The usual reasons for this are simple (although rarely admitted openly): the scientists who collected the data want to keep mining it for more discoveries, so why share it? Sometimes, too, researchers package up the data and sell it, which is completely legal, even though the government paid for the work.

(It’s not just medical research data, either: once I tried to get some data from a paleontologist, only to learn that he treated every fossil he ever collected as his personal property. But that’s a blog for another day.)

Many scientists have been fighting this culture of secrecy for a long time. Our argument is that all data should be set free, at least if it’s the subject of a scientific publication. It’s not just scientists making this argument: since the early 2000s, patient groups began to realize they couldn’t even read the studies about their own diseases unless they paid a for-profit journal to access the paper. Those groups lobbied–successfully, after a years-long fight–that any publicly-funded research had to be published on a free website, not locked behind the doors of private publishers. Their effort led to an NIH database called PubMedCentral, which contains the full text of thousands of articles.

The new NIH data sharing policy is one consequence of the Open Science movement (which I’m a part of), which argues that science moves much faster when it’s done in the open. This means sharing data, software, methods, and everything else. There’s now a U.S. government website dedicated to Open Science, open.science.gov, which includes more than a dozen federal agencies including NIH, NSF, and the CDC.

A bit more history: as far as I can tell, the earliest voices for data sharing emerged during the Human Genome Project, an international effort beginning in 1989 that produced the first draft of the human genome in 2001. When a private company (Celera Genomics) emerged in 1998, a dramatic race ensued, and as one strategy for competing, the public groups announced that, in contrast to the private group, they would release all their data openly on a weekly basis, long before publication. That wasn’t how things had worked before.

Very soon after that, scientists in genomics (my own field) realized that all genome data, whether from bacteria, viruses, animals, or plants, ought to be released freely. The publicly-funded sequencing centers received millions of dollars to generate the data, but they weren’t the only places who could analyze it. NIH and NSF agreed, and pretty soon they required all sequencing data to be released promptly.

This same spirit didn’t touch most medical research, though. Even though far more money–billions of dollars a year in NIH funds–is spent on disease-focused research, data from those studies remained locked up in the labs that got the funds. This is now changing.

As the Yale scientists (Joseph Ross, Joanne Waldstreicher, and Harlan Krumholz) point out in their NEJM editorial, open data sharing has already yielded tremendous benefits. For example, they point out that hundreds of papers have been published using public data from the NIH’s National Heart, Lung, and Blood Institute, including studies that revealed new findings about the efficacy of digoxin, a common drug used to treat heart failure.

The new NIH policy covers all of NIH, not just one institute, and we can hope it will unlock new discoveries by allowing many more scientists to look at the valuable data currently kept behind closed firewalls.

But simply requiring scientists to have a “data management and sharing policy,” as the NIH is now doing, might not be enough. Many thousands of scientific papers already say they share data and materials–but as it turns out, the authors don’t always want to share.

A study published last year illustrated how toothless some current policies are. That study identified nearly 1800 recent papers in which the authors said they would share their data “upon request.” They wrote to all of them, only to find that 93% of the authors either didn’t respond at all, or else declined to share their data. That’s right: only 7% of authors shared their data, despite publishing a statement that they would.

The NEJM editorial proposes a different solution, one that could be far more effective: putting scientific data into a government repository. This is something the government itself can enforce (because they control the funding), and once the data is in a public repository, the authors won’t be able to sit on it as (some of them) now do.

It’s good to see NEJM joining the open science movement. Science that is shared openly will inevitably move faster, and everyone–except, perhaps a few data hoarders–will benefit.