Seattle Karma

Wait, what?  How can something that doesn’t work, help?  And if it helps, doesn’t that mean it works?

There is a new study out today (Reuters, Seattle PI) from the Group Health Center for Health Studies that shows acupuncture provides at least some benefit to people with chronic lower back pain.  I’m sure that acupuncture devotees will latch onto this study as meaningful proof that acupuncture works, but they should pause before popping the champagne cork:  the study also demonstrated that it didn’t matter if you used needles or toothpicks, or whether you penetrated or didn’t penetrate the skin.  Although this study didn’t run a test group that received acupuncture using non-acupuncture points (it would have been more thorough if it had, and I wonder why it did not), the results match other studies that have done exactly that, so it’s safe to say that acupuncture works whether you’re receiving “real” acupuncture or not.  The mere act of poking someone in the back with something sharp (maybe not even that; other studies have shown that fingertips will do) and telling them they were being treated with acupuncture was good enough to realize the same amount of benefit across the board.  The conclusion of the study was this:

Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.

As the conclusion suggests, what we’re probably seeing here is the famed placebo effect at work – if someone genuinely believes that a sham treatment will work, sometimes it does.  Whatever the real reason, the study makes it clear that the mechanism of action – why does acupuncture work? – remains a mystery.  Traditional Chinese medicine claims that acupuncture releases qi energy, but such energy has never actually been observed and is not scientifically recognized.

So, even if acupuncture is chiefly a matter of belief, what’s the harm if it provides relief?  It may be fair to say that, for some, acupuncture helps.  But it most likely doesn’t “work”, meaning that there is no mechanism by which acupuncture itself treats anything.  The suggestion that it will treat something and the strong beliefs of many of its patients probably contributes greatly to its anecdotal success, but it is important to note that the placebo effect is not a miracle worker.  It won’t make a tumor go away just because a patient believes it will.  And this is where the danger lies – people tend to attribute far too much power to the placebo effect, thinking that it doesn’t matter if the treatment works or not as long as it helps.  If you merely feel pain, yes, a placebo treatment may help, probably because a great deal of pain is in the mind and a matter of perspective and attitude.  But if you have a condition such as cancer or a viral infection or what have you, the placebo effect isn’t going to do anything.  Tumors don’t have beliefs and are not affected by placebos.

The whole study can be found here. It’s pretty accessible to the layman and well worth a read, especially the discussion at the end.

It’s being reported (Seattle Times, Seattle PI) that the H1N1 “swine flu” influenza virus has taken the life of a man in Snohomish County, the third death in the US from the virus.  He was in his 30s and had an underlying heart condition.  Apparently, there are 101 confirmed cases of H1N1 in the state of Washington, with about 75% of them striking children under 19 years of age.  There are several more cases considered “probable”.

I know a lot of people are concerned about this, but a little perspective is in order:  the “swine flu” is not particularly different from any other strain of flu.  They all operate the same way:  influenza is an infectious disease caused by a family of viruses that affect birds and mammals.  All flus have the same common symptoms:  chills, fever, sore throat, muscle pains, headaches, coughing, weakness and general discomfort.  All flus can cause pneumonia, which is what this man ultimately died of.  All flus in the United States cause about 36,000 deaths per year. Most of us recover from the flu just fine, which is why everyone thinks it’s no big deal, and most people I know don’t even think that it kills anyone (so when they hear the media reporting on swine flu deaths, they freak out, thinking it’s a “different” kind of flu).  But it does, all the time, usually the very young and the very old, who tend to have compromised immune systems.  Many more deaths occur in people who already have pre-existing health conditions.

Some people are concerned that it was not reported exactly who this man is, where he lives or what community he hails from.  But it doesn’t matter where he lives – flus spread easily over the air and with so many cases in the state at any given time, there is no way to avoid the flu by staying away from certain areas or communities.  It is everywhere already.  The flu is not something that is practical to try and contain; there are thousands of active cases at all times of the year.  If you want to try and avoid the flu (and you should), you do the usual things you do to avoid all sickness:  wash your hands, cover your face when you cough or sneeze, avoid others who are coughing or sneezing, and for crying out loud, if you’re sick or your children are sick, stay home from work and keep the kids out of school!  Nothing drives me more crazy than selfish oafs who feel they have to show up to work or ship their kids off to school with snot running down their swollen faces – think of others and keep your flu to yourself.

It’s important to note that the swine flu is just that – another flu.  It’s no different or especially dangerous compared to other flu viruses.  It is not something you want to get, just like you don’t want to get any kind of flu, but I am not sure why the media is making such a big deal out of this particular flu.  New strains pop up all the time.  Around the world, flu spreads every year in seasonal epidemics and kills hundreds of thousands – a big deal, to be sure, but it’s no bigger with the swine flu than any other.  I guess particular attention is being paid to the swine flu because it’s new, but I know people who are especially worried about this particular flu, when in reality it presents no more danger than any other flu.

So, if you’re worried about the swine flu, you should be worried about all flu, and if you’re going to worry about all flu, well, that’s a pretty good way to needlessly make yourself paranoid and miserable for no good reason.  “Worry is like interest paid on a debt that never comes due.”  Pretty much all of us will get the flu several times in our lives, and it’s just part of being a living biological animal on this planet.  Most of us will not die from it – our bodies are pretty good at fighting this sort of thing off.  This is not to say the flu need not be taken seriously.  If you get sick, you should definitely take good care of yourself with lots of rest and liquids, and if you’re feeling especially bad you should see your doctor and follow his advice to the letter.  The flu does kill and should be taken seriously.  But you need not worry about it excessively, no more than you’d worry about being involved in a fatal automobile accident or suffering a heart attack or any other of the hundreds of myriad events that could claim your life each and every day.  If you worry about those things all the time, see a therapist. 

More information on the swine flu at Wikipedia, King County Public Health Department, Seattle Local Health Guide, and the World Health Organization.