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Is this serious science?
Posted by LandOfWoo on 11 Sep 2010 at 11:23 GMT
I'm pretty amazed that such a poor quality study made it past the editors. As far as I can tell, the paper only says that stimulating different parts of the body produce responses in different areas of the brain.
In now way, does this trial indicate an effect of acupuncture itself - at the very best it shows some effect that lasers on the skin can produce in the brain. The choice of locations wasn't tested against any controls and in fact the absence of any control ought to have alerted the editors to the fact that this is not serious science.
The experimenters weren't blinded, and neither were the reviewers of the fMRI, and the conclusions don't follow from the evidence collected, such as it is.
This is a very very poor trial and for me at least, it questions the editorial standards of PLoS.
For anyone interested in the scientific study of hypotheses related to acupuncture, this paper provides nothing. Surely, before trying to relate the brain effects to stimulating acupuncture points, we first have to establish unequivocally that there really are acupuncture pressure points and not simply a claim that there are. This hasn't been established and in the paper it is simply an assumption.
I am truly surprised that PLoS let this paper get published. No control, no double-blinding, an unfounded assumption as the basis of a conclusion, this is just too poor to take seriously. I hope this serves as reminder to editors that many people reading these papers can see when bad science is accepted, and that it damages the reputation of the editors (if they are identified) and certainly PLoS.
The unfortunate consequence for science, though beneficial for the advocates of acupuncture, is that this paper will now almost certainly be used in marketing material on websites and in acupuncture literature. The use of publications with low editorial standards is an important part of the marketing of unevidenced alternative medicine claims, because they can take advantage of the academic reputation of the publishing body.
I hope this was not intentional on the part of PLoS.
We think that the reader may have misunderstood the objective and design of the study.
We began with the objective that since laser acupuncture is being used for the treatment of depression, as well as other neuropsychiatric disorders, its effects should be examined to determine its 'biological plausability' as a treatment. This is especially important as laser acupuncture does not produce the skin sensation traditionally associated with needle acupuncture. Indeed, laser stimulation in this case is not felt by the individual.
The design was a classical on-off block design. The subjects is blinded as he or she cannot tell when the laser is on or off, and teh BOLD effect is examined as the difference between the on and off phases. The operator is blinded when the switching off and on is done remotely by a computer program. The data analysis is largely automated.
The laser stimulation is restricted to the skin,and the change in BOLD signal in a number of brain regions is an empirical observation, the mechansims not being currently undersood.
If there is any criticism of the study, it could relate to the small sample size, but we have been conservative in our thresholds. Of course, any such study needs independent replication before the findings become generally accepted. We have repeated the work in depressed patients, with similar results which are being written up for publication. We have also performed a comparison of laser and needle acupuncutre, for future publication.
Perminder Sachdev for the authors
" since laser acupuncture is being used for the treatment of depression, as well as other neuropsychiatric disorders, its effects should be examined to determine its 'biological plausability' as a treatment. "
Therein lies the biggest problem with the conception of the study. You have assumed that since laser acupunture is being used, it therefore represents a real phenomenon which necessarily produces an effect relevant to the target of the claimed treatment.
You have jumped from the fact that it is being used as a treatment, to assuming that therefore there will be a measurable effect related to the target of the treatment. That's not the case. If the treatment is simply the fanciful notion of someone who believes in acupuncture, any response detected in the brain could simply be the consequence of any contact with that particular part of the body.
You trial is flawed not simply by small sample size but by assuming the consequent. You have assumed that acupuncture has an effect simply because someone has used it in the treatment of depression. You cannot use such an assumption to justify looking for a causal explanation of its efficacy - just like all other science, you have to demonstrate efficacy first.
You will be aware that there are studies demonstrating that acupuncture is no better than placebo and on that basis alone, it is inappropriate to take as an assumption that acupuncture actually works. This paper is little more than an article of faith.
I think I have understood very well the objective of the paper and it remains with you to demonstrate you have produced evidence in the absence of the prior assumption that acupuncture works. You haven't done that with this paper.