Calling out fake medical journals that exist to promote acupuncture

Comic strip by Rudis Muiznecks, cectic.com

Fake news has been in the news a lot lately. Fake news proliferated wildly during the 2016 U.S. election, much of it completely fabricated, usually with an extreme partisan bias. Fake news is corrosive. It mis-informs the public, divides people against one another, leads to bad policy decisions, and can even induce people to take action against imaginary threats.

One might think that medical literature is immune from this kind of fakery, but it's not. Recent years have seen the appearance of journals from mainstream publishers that are based entirely on pseudoscience. On the surface, these publications look and act just like real scientific journals, but it's all just pretend. The publishers of these journals presumably care more about their bottom line than about scientific integrity. They know (or seem to know) that journals about pseudoscience will create a never-ending demand for fake breakthroughs and science-y sounding studies that are built on a house of cards.

I've decided to start out the new year by calling out these fake medical journals for what they are: complete and utter nonsense. First, a bit of background.

Imagine for a moment that a publisher created a Journal of Magical Medicine under the rubric of a large, respectable publisher–for example, Elsevier. After assembling an editorial board of academics from legitimate universities who believed in magical medicine, the journal started soliciting and reviewing papers. The editors would send any submissions for review to other academics who believed in magic, and over time a steady stream of peer-reviewed papers would emerge. A large network of magical medicine "experts" would develop, reviewing and citing each others' papers, and occasionally writing review articles about the state of the art in magical medicine.

Dr. Harriet Hall has accurately called this "tooth fairy science." I prefer to call it "cargo cult science," because its practitioners mimic the behavior of real scientists without actually understanding science itself.

Of course, no self-respecting scientist would want to waste his or her time reading garbage, so most scientists would simply ignore the Journal of Magical Medicine. But it would persist anyway.

This is exactly the situation we're in now, but as you might guess, the Journal of Magical Medicine doesn't exist. Instead, we have multiple journals devoted entirely to something just as fanciful and just as unbelievable: acupuncture. Here are three examples:

• The Journal of Acupuncture and Meridian Studies, published by Elsevier
• Acupuncture in Medicine, published by BMJ
• Chinese Medicine, published by BioMed Central (owned by Springer)

These aren't the only ones, but they'll do for an illustration. I can't help pointing out that the Elsevier journal has a bonus bit of magic in its name: "meridians" are a completely imaginary concept, referring to invisible lines of energy that supposedly flow through the body. This is a perfect (if unintentional) example of magical medicine. How nice that Elsevier provides a journal for people who want to study it.

Prof. Edzard Ernst has pointed out that these journals, and others like them, are a farce:

"Potential authors ... are invited to suggest their preferred reviewers who subsequently are almost invariably appointed to do the job.... As a result, most (I estimate around 80%) of the articles that currently get published on alternative medicine are useless rubbish."

If anything, Prof. Ernst is being overly generous.

Looking over the articles published in the latest issues of these journals is painful (if you care about good science, that is). For example, the BMJ acupuncture journal features "Needling depth at BL52 in 13 cadavers," an article about inserting needles into dead bodies. Why study this? Because (as the paper explains) acupuncture needles can damage the kidneys if they are inserted too deeply. Here's another example, from Elsevier's acupuncture journal: "Effect of Manual Acupuncture Stimulation at `Bai-Hui' (GV 20) or `Yintáng' (Ex-HN3) on Depressed Rats," a study that concludes that acupuncture helps alleviate depression (in rats, mind you!) but only if you use two acupuncture points simultaneously. Right.

There are thousands more articles like these. It's an entire ecosystem of pseudoscience.

Let's be clear: acupuncture is "a pre-scientific superstition" that has no basis in medicine, physiology, or biology, and has never had any good scientific evidence to support it. It wasn't even popular in China until Chairman Mao re-invented it as part of "traditional Chinese medicine." Mao did this because China didn't have enough real doctors to treat its large population, and he wanted to convince the masses that their local herbalist was offering something just as good. China is still pushing this today, for the same unscientific reasons.

I've been advised that I should treat acupuncturists and acupuncture believers with respect, and that I should accept that they have some legitimate claims because some patients like them. I've tried this approach, and it doesn't work: acupuncture continues to spread, in part because of very badly-done studies that often misrepresent their findings. I've read enough acupuncture studies for one lifetime, and acupuncture doesn't work for anything. It's nothing more than an elaborate, theatrical placebo, performed by quacks to convince unwitting victims patients that the acupuncturists have something real to offer. They don't.

Trying to refute the claims of acupuncture (see here and here, and again here, for example) is like playing whack-a-mole. Proponents claim it cures dozens (or hundreds) of different conditions, and each time a claim falls flat, they simply make up a new one. Acupuncture also carries small but real risks to patients, who can suffer infections and sometimes much worse, such as punctured lungs.

Elsevier, BMJ, and Biomed Central should be embarrassed to publish these fake medical journals, which serve only to promote pseudoscience. Their very existence can confuse medical students, who assume (as they've told me themselves) that if legitimate-looking journals are publishing this stuff, there must be something to it.

Despite their appearances, the Journal of Acupuncture and Meridian Studies, Acupuncture in Medicine, and Chinese Medicine are not real medical journals. They are fake journals filled with fake science, and the world would be a better place if they all disappeared.

Stabbing kids with needles: malpractice, or just a very bad idea?

Yesterday's Washington Post featured a terribly researched article titled "Kids and needles is sometimes a good match: Acupuncture can help with pain."

Imagine: a one-year-old boy arrives at an emergency room in New York at 3 a.m. with an asthma attack.  He is slow to respond to a nebulizer treatment.  Enter Dr. Stephen Cowan, who decides to use acupuncture.  That's right, he stabs a one-year-old baby with multiple needles to treat asthma.  According to Dr. Cowan, the boy "reacted calmly" and improved.  The article doesn't provide any more details.

This is appalling.  Sticking needles into a baby has never been shown to have any effectiveness at treating asthma, and we do have treatments that work.  In all likelihood, the nebulizer did work, in the case that Dr. Cowan related to the reporter, but Dr. Cowan mistakenly credits his acupuncture treatment.

Stephen Cowan is a aggressively self-promoting doctor, who claims on his website that he can treat both autism and ADHD with acupuncture and other forms of Chinese Medicine.  He also describes how he convinces children to let him stick needles into them.  He states his belief in mystical "vital energy" or qi, one of the wacky pseudoscientific notions at the core of acupuncture beliefs.  His claims are little more than a modern, mystical version of the claims made by 19th-century snake oil salesman.

The Washington Post story also revealed that Children's National Medical Center in Washington, D.C. recently treated a 17-year-old girl with pancreatitis by stabbing needles into her stomach and other places.  There is no evidence that this works, but the girl's doctor believes it does.  The girl reportedly wasn't harmed, fortunately.

The doctor at Children's Hospital, Jennifer Anderson, is an anesthesiologist who is also an acupuncturist.  In the story, she said "I often treat patients with chronic issues" with acupuncture.  This is frightening: a doctor at a major medical center is telling children, most of whom are too young to even think of questioning the wisdom of a doctor, that sticking them with needles will help their pain.  Dr. Anderson admitted that "she often does two to three treatments a week at first on a child."  So she admits to stabbing many sharp needles into children and telling them that the treatments will help their pain.  She argues that the children report that this is "helpful."

This is perilously close to child abuse.  Children want to please adults, and if an adult tells them something is good for them, especially if an authority figure tells them, they are extremely unlikely to disagree. They'll just swallow the medicine, or endure the treatment, and then tell the adult what she wants to hear.  Dr. Anderson seems unaware of this.  And Children's National Medical Center, a generally outstanding hospital, should be seriously concerned that one of its anesthesiologists is practicing quack medicine on children, who are perhaps the most vulnerable of all patients.

Let's be clear: acupuncture is based on nonsense.  Scientists have gone to great pains to study it, and the conclusion can be stated simply: acupuncture does not work.  (And yes, I know about the latest meta-analysis claiming that acupuncture works.  Dr. Steven Novella has already explained why that analysis is "completely useless.")  If acupuncture were a drug being tested by a pharmaceutical company, it would have been abandoned long ago.  Its proponents are no better than any big pharma company that pushes a drug that it knows to be ineffective.

Acupuncture is worse than ineffective: because it's an invasive procedure, there is a small but real risk of harm.  As I wrote last year in The Atlantic, acupuncturist sometimes cause infections, which can lead to rare but serious complications.  Acupuncturists protest (often) that they use sterile needles, but this very protest reveals their ignorance: most infections are caused by bacteria already present on the skin, which enter through the puncture wound.

Parents: don't let an acupuncturist stick needles into your kids.  Read the science first, and avoid - no, run screaming from - any practitioner who claims that he can adjust the "qi" in your child.

Kill the tigers

Here's a choice: save the last remaining tigers on the planet, or kill them, chop them into pieces, and eat them in the mistaken belief that tiger parts can be used as medicine.

Sounds like an easy choice, no? Unfortunately, humans have already decided to kill the tigers rather than saving them. Fewer than 4,000 wild tigers survive on the planet. As journalist Caroline Alexander wrote in a compelling article in the December issue of National Geographic, "tigers in the wild face the black abyss of annihilation." And their greatest threat, she writes, is "the brutal Chinese black market for tiger parts."

Traditional Chinese Medicine (TCM) practitioners claim that tiger parts can be used to treat a wide variety of ailments, including malaria, bacterial infections, bad skin, ulcers, leprosy, and impotence. There is not a whit of scientific evidence to support any of these claims; they are nothing more than folk medicine, based on primitive beliefs dating from a pre-scientific era, when it was believed you could acquire the properties of an animal by eating it. Unfortunately, these beliefs have driven the mightiest of the big cats to the brink of extinction.

The World Federation of Chinese Medicine Societies asked its members to stop using tiger bones last year, but their action is far too little, too late. The New York Times reported around the same time that tiger-based "medicines" are widely available in China.

Proponents of Traditional Chinese Medicine claim that it is beneficial, but they have no science to back them up. NIH's National Center for Complementary and Alternative Medicine (NCCAM), an apologist for all sorts of quack medical practices, explains that

"In the TCM view, a vital energy or life force called qi circulates in the body through a system of pathways called meridians. Health is an ongoing process of maintaining balance and harmony in the circulation of qi."

This is little more than fantasy. Too bad NCCAM's leaders seem to have forgotten whatever they knew about human physiology. They might just as well explain that midi-chlorians circulating in the blood are the source of the Force. (Actually, there are midichlorians in nature now, in a species of tick.  Really.)

Some forms of "alternative medicine" are ineffective but mostly harmless (think homeopathy, which is just water and sugar pills), while others can be harmful to the patients who use them (think acupuncture, with its risk of infection, or ayurveda, which uses toxic chemicals). TCM is doubly harmful: it doesn't benefit patients, and it is the single greatest threat to the world's tigers. I hope people come to their senses before the last tiger is gone.

Pseudoscientific Chinese Medicine infiltrates scientific publishing

So it turns out that Chinese Medicine has its own journal, published by BioMed Central, a large scientific publisher. The Chinese Medicine journal promotes, according to its own mission statement, studies of "acupuncture, Tui-na, Qi-qong, Tai Chi Quan, energy research," and other nonsense. Tui na, for example, supposedly "affects the flow of energy by holding and pressing the body at acupressure points."

Right. What is this doing in a scientific journal? Actually, there are plenty of garbage journals out there, and I'd ignore this one like I do the others, but BioMed Central (and their owner, Springer Science) is a respectable publisher. It's also one of the largest open-access publishers, which means they make all their articles from their 213 journals freely available. I support BMC and I'm on the Editorial Boards for three of their journals (BMC Biology, BMC Genomics and BMC Bioinformatics). But their corporate leaders seem to care more about expanding their stable than about maintaining the integrity of science. Chinese Medicine simply does not belong in the company of respectable scientific journals.

What is "Chinese Medicine" anyway? (Should we also have journals for Russian Medicine, or American Medicine, or Swedish Medicine?) Actually, the name refers to what is usually called Traditional Chinese Medicine, or TCM. TCM is a grab-bag of superstitious practices taken from Chinese history, most of which are ineffective or even harmful. The most common justification for studying TCM (and using it on patients) is something along the lines of "this is an ancient Chinese practice" as if anything old must be worthwhile (also known as the argument from antiquity, a logical fallacy). But using the term "medicine" to describe Qi-gong, acupuncture, and "energy research" is, to put it bluntly, nonsense.

And by the way, "energy research" in this context doesn't refer to methods for producing electricity. No, the energy research in this journal refers to mysterious energy fields in the body, stuff like the "deqi" in this article from the January 2011 issue of Chinese Medicine: "Perception of Deqi by Chinese and American acupuncturists: a pilot survey." It's a laughably bad study, but here's a link for those with a high tolerance for quackery.

Ancient medicine was almost always bad medicine. People died very, very early in those good old days, and ancient China didn't have any special secrets. 2000 years ago, if you were lucky enough to survive past childood, you might just make it to your 30's. Life expectancy has climbed dramatically in recent times, for the past 150 years or so, thanks to modern hygiene and medicine. So forming a scientific journal whose goal is to validate antiquated, unproven superstitions is simply not science, whatever the editors of Chinese Medicine claim. The journal's claim to be "evidence-based" (yes, they do claim that) is little more than a smoke screen.

BioMed Central publishes at least one other pseudoscience journal, BMC Complementary and Alternative Medicine. BMC should be embarrassed to be publishing journals that promote anti-scientific theories and otherwise muddy the literature. By supporting these journals, they undermine the credibility of many excellent BMC journals. They should cut these journals loose.