So its effectiveness is about on par with faith healing, got it.

The placebo effect is a helluva drug

No, it really isn't. Its help rate can be as low as 15%. Using anything that is only 15% effective as a drug is not only not effective, but can easily be mistreatment. Most of the time, you have to lie to the patient so they can get an effect (IF they get it at all) and then you often have a drug that is consistently more effective than the placebo.

It isn't a helluva drug. It is a bad drug that often simply won't work for you.

It can be. And it's not all positive. The nocebo effect can be so strong, that people actually die because they think they are cursed (other examples: Covid vaccines, statins, ...).

Any generalised statement about the effect of placebo/nocebo is difficult, because some portion of the effect is regression to the mean, and relatively little is known about the mechanism of action (e.g. there is some indication about a genetic factor).

Not disagreeing with you that it may not work for you, but it may work quite well for some people. Acupuncture being a prime example.

We need to throw out Allopatic medicine that does not work, along with Acupuncture, Chiropractic, Naturopathic, Osteopathic bad healing techniques that work slightly better than Placebo in an Indian village in studies with less than 100 poor souls, and a questionable Control group, and rumors of payola floating around.

Meaning enough with the bullshit remedies that don't work.

Most Psychiatry drugs are on my hit list.

I can't believe these $450 a visit fancy boys are allowed to prescribe 90% of their bread and butter drugs. I'm not just picking on shrinks either, but they are an easy target.

I am beyond disillusioned that our FDA has approved drugs that are harmfully and actually don't work.

(Former Chiropractic student who walked out after hearing, "We have over 15 upper cervical techniques--and they all work Equally well.")

Enough is enough.

Then it is a good thing you have no say in our access to psychiatric pharmaceuticals.

The only way known to distinguish one variety of depression from at least a half-dozen others is to see which medication relieves it. So, any RCT of a depression treatment necessarily throws together people with a half-dozen or more independent conditions, some of which might be relieved by the treatment, others worsened.

Repeat after me: RCT results depend absolutely on precise and correct diagnosis. If you cannot diagnose, you cannot design a valid RCT. Invalid RCTs are easy, though; people run those all the time. The RCTs that seem to prove psychiatric drugs are ineffectual are exactly those.

We are in the condition of people getting arm and leg fractures, but we can't tell where. Splinting is seen to help; doctors who put splints on various places usually hit on a place where it manifestly helps. But our RCTs of splints placed on left shinbones seem to help only a precious few of our patients. Some people swear up and down, loudly and repeatedly, that they are dead certain this means splints are useless and a big scam.

to start off, i do not "understand" the "homeopathy" to either dismiss it as mumbo jumbo and dangerous but my granddad was a medical practitioner and he is said to have used homeopathy but not in the sense people use it now.

i'm told he strictly used it literally as a placebo ONLY when he knew the cause of the "problem" was not physical or something wrong because of infection or something. I'm told he would treat patients with depression by counseling without telling them (usually family members) and prescribing this "white medicine" to keep up appearances.

i'm told he never treated anyone outside of this usecase because well, there are medicines for that purpose.

remind you this is from 50 years ago when my town had 3 hospitals in total and there was no "medical equipment" like we have currently or that were available in major cities. Call it the neck of the woods so its not like there was modern medical care available but patients didn't seek it. He was the physician of his time and pretty successful at that.

No. These junk "remedies" like acupuncture absolutely have risks. You can get infections from acupuncture. Your acupuncture "provider" could easily infect you with bloodborne diseases.

People have even been documented to have died from acupuncture https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2951167/

The benefits are zero. Potentially living with a chronic disease like Hepatitis C because of a lazy provider that reuses a needle or contaminates it in some way, is a serious risk.

There's also the fact that by engaging in these activities you perpetuate junk science, just like Q anon people, just like climate change deniers, it's all the same insanity.

Let me try again, maybe with more caps.

> We are pretty sure acupuncture, DONE CORRECTLY, won't cause any harm

Yes, if you get stabbed with a dirty needle, you might get a disease. That's true for acupuncture, a tattoo shop, and even a vaccine. Don't get stabbed with dirty needles! I fully suggest not getting stabbed with dirty needles. Bad. Avoid. 0/10.

> The benefits are zero

https://pubmed.ncbi.nlm.nih.gov/3982837/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5984198/

It's probably about as effective as placebo? (Maybe?) That isn't zero, that's placebo - and that is an important difference

> you perpetuate junk science,

You're just wrong. This isn't even just a "you might have a different opinion". The absolute best science we have, the entirety of realms of research, is "well, it's probably placebo and maybe it's kind of an expensive placebo". The most scientific answer you can give is "we should do more studies and ask more questions", and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".

One of the ways I avoid getting stabbed with a dirty needle is based on background rates. I think I'm safe in sticking with my priors that acupuncture clinics are held to less of a standard than vaccines are. Hypodermic needles necessarily come in sanitized packages, after all.

There's more to science than just asking questions and collecting data though, there's also developing models. Without good models, you can't gain much insight from data, and in fact you'll sometimes gain incorrect understandings. If there's no supported mechanism for how acupuncture works, it's really not a good sign, and it seems dishonest to think it's at all in the same realm of safety as something like vaccines which do have known mechanisms of action.

I think back to how much "data" we had in the 50s that tobacco was harmless. Is it ever a good idea to go for something so invasive to the body as needles without a strong reason, just because the dangers aren't readily apparent? Medicine passes the necessity bar, placebo does not.

Dunno, I had some acupuncture sessions as recommended by my doctor.

The accupuncturist's needles were each individually packed, he washes his hands thoroughly, then puts on gloves as well. Every needle gets thrown away immediately after use.

Not sure how any of that is potentially unhygienic other than the room itself possibly being slightly dirty? (it was clearly well cleaned, but obviously not to surgical standards... why should it?)

> If there's no supported mechanism for how acupuncture works, it's really not a good sign

Acupuncture works as well as sham acupuncture (inserting needles at non-acupuncture locations). Which suggests to me that acupuncture works on the same basic principle that your doctor giving you sugar pills with a fancy name and strict instructions to take one every four hours with a glass of water works.

> I think back to how much "data" we had in the 50s that tobacco was harmless.

We had pretty good evidence it was bad for you, especially during pregnancy. This is maybe a better example for talking about peer review and conflicts of interest - which is still a real problem.

We can never say "is dangerous" or "is not dangerous". What we can say is X esposure leads to Y harm. Water in sufficient quantities will kill you.

Acupuncture, in a sterile environment, is pretty safe. We also know that skin deep needle penetration is pretty safe given that lots of people get tattoos. It still requires hygiene, but it is a safe activity.

I'm totally sympathetic to "we should be doing health inspections of acupuncture, like we do tattoo shops". I think some areas already do this. It's probably a good idea.

> Which suggests to me that acupuncture works on the same basic principle that your doctor giving you sugar pills with a fancy name and strict instructions to take one every four hours with a glass of water works.

Except that sugar pills don't give anyone HIV or Hep C.

> We can never say "is dangerous" or "is not dangerous". What we can say is X esposure leads to Y harm. Water in sufficient quantities will kill you.

No. Harm is relative to reward. Cancer drugs are extremely harmful. But dying from cancer is worse.

The reward for acupuncture is 0. Just sit and eat a Twix instead. It has the same medicinal benefits. The harm of acupuncture is absolutely real, as I linked above, people have died, people have gotten chronic diseases.

> You're just wrong. This isn't even just a "you might have a different opinion". The absolute best science we have, the entirety of realms of research, is "well, it's probably placebo and maybe it's kind of an expensive placebo". The most scientific answer you can give is "we should do more studies and ask more questions", and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".

No. That's junk science. There's no different opinion here. It's very clear from many many studies of acupuncture it does nothing. This kind of attitude sells people on something that does not work.

> The most scientific answer you can give is "we should do more studies and ask more questions"

Absolutely not! I am a scientist. That's a total dumpsterfire of an answer. This is how people end up with people taking crazy COVID "treatments", because we "need more study". As a community we have studied this trash extensively now. It is junk. That's it.

If acupuncture was a drug, it would be so widely discredited you couldn't get $1 to do a study. Actually, you couldn't even run a study on it because your local ethics board would think the potential harm for benefit ratio would not be good. The only reason people keep studying this is because dishonest people sell other people on acupuncture as a treatment, so it's a neverending cycle. As long as people keep wanting to engage with this junk, the scientific community needs to keep studying it, we keep finding it's total trash, but then people like you say "Oh look, people are studying it, therefore there is merit". There is no merit.

> and it's part of why the medical industry has shifted from "Don't do acupuncture" to "Well, it probably won't do much for you, but sure if you like it, that seems fine".

The medical industry cannot police snake oil salesmen. This is a well known problem. People get all sorts of insane treatments. From having your back violently adjusted by chiropractors (another junk science where people die) to having the crap beaten out of them with stainless steel rods (something called the "Graston technique"; I have seen the outcome of this, it can be horrific).

A central concept in medicine is that the patient gets to lead the charge. And attitudes like yours are exactly why so many people get caught up in this pseudoscience junk. To immense detriment to their health.

In my book, a medical treatment that does not beat placebo is ineffective. That's also what we are asking pharmaceutical companies to prove through those double blind studies.

If acupuncture does not beat placebo, lets direct people to homeopathy instead - which basically means drinking water - to get the exact same placebo results. There are less risks associated with drinking water than being stabbed with needles, dirty or not. We could even have those cost fully covered by the state, few millilitres of water won't bankrupt anyone.

You are conflating effectiveness (change in outcomes) with efficacy (change in outcomes relative to placebo or other intervention). Both are worth knowing, because usually there are no free lunches to be had - interventions (also those that are known placebos!) can have negative side effects.

Not sure if that's what you meant: In Germany, e.g. acupuncture (and other specific types of homeopathic treatments) are reimbursed by public health insurance, for specific conditions. Exactly because they can induce a significant beneficial placebo effect on average while having less risks, and being cost effective.

BTW, depending a bit on jurisdiction, placebos are routinely given even in hospital care. If you have family/friends who are doctors, do ask them.

My main points is that I do not believe that it's OK for the state to be paying for things that have not proven their efficacy. My whole relatives are MD Doctors (father, 5 sisters, wife and best friend) and they all agree that we are lacking funding for the health sector as a whole, so paying for people beliefs isn't a priority.

On top of that, it puts the state in a weird situation because it has to decide which beliefs are OK (acupuncture fixes fibromyalgy is an OK belief -> reimbursed) and which one aren't (getting a PS5 fixes depression is not and OK belief -> not reimbursed).

People are absolutely entitled to have their own beliefs, but if a treatment hasn't shown any efficacy, we should aim for a close to 0 spending of the public health sector on it.

I feel that creating a state controlled millilitre water bottling company would make some placebo available at virtually no cost, so could be a nice way of offering some effectiveness for free, but acupuncture isn't.

Agreed.

On top of that, opportunity cost is a thing. If you pursue completely ineffective therapy - and spend time figuring out if your local acupuncture parlor uses dirty needles - you waste time and energy that would be spend pursuing worthwhile treatment.