Anti-Doping in Practice from Player's Perspective

[tapir]

Can we please start a discussion on acupuncture, here. Should all players get needled before tournaments or should it remain voluntary?

http://www.usgo.org/news/2010/12/couldn ... ight-help/

[kirkmc]

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

[topazg]

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

That's an amazing leap of false logic

[kirkmc]

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

That's an amazing leap of false logic

What? The fact that it's a sham (which is true), or the fact that sham medicine often uses the "couldn't hurt" argument (which is true as well)?

[averell]

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

That's an amazing leap of false logic

What? The fact that it's a sham (which is true), or the fact that sham medicine often uses the "couldn't hurt" argument (which is true as well)?

Many people are willing to pay 100-200% markup just because a product has white plastic or a fruit logo. Doesn't mean it's a sham, everybody is happy. Also, even if the scientific basis is similar to homeopathy, placebo effects are significant, so it does work for some people.

[tapir]

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

They won the tournament. So, it didn't hurt

[topazg]

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

That's an amazing leap of false logic

What? The fact that it's a sham (which is true), or the fact that sham medicine often uses the "couldn't hurt" argument (which is true as well)?

Well, it's your opinion that it's a sham, which isn't the same as being fact. A lack of evidence for something working doesn't mean it doesn't work, and I'm not aware of a large number of papers showing a null effect - absence of evidence isn't evidence of absent. There are even some (including recent reviews on specific health issues) that actually appear to show a positive effect in practice of acupuncture, though this is outside the field of science that I spend much of my time. I don't believe in it particularly, but I haven't spent a great amount of time looking for its possible effectiveness - however, I don't disbelieve in it for the same reason. You can't prove a negative, but you can systematically and repeatedly demonstrate a null in bigger and better conducted studies until you finally have to conclude there's nothing to look for. That hasn't yet been done for acupuncture as far as I know.

But no, the false logic was saying "just because sham medicine and acupuncture can be referred to as couldn't hurt, might help, acupuncture is a sham". If I have a headache, I might drink some water - if I'm dehydrated and that's causing my headache, that will help. If it's something else, it probably won't. However, it probably won't hurt, so "couldn't hurt, might help" could be applied to that drink of water - does that make water helping with headaches a sham too?

[kirkmc]

If you want to read about acupuncture, and the supposed longevity of the technique, its results, etc., this is a good document:

http://www.centerforinquiry.net/uploads ... _Paper.pdf

But no, the false logic was saying "just because sham medicine and acupuncture can be referred to as couldn't hurt, might help, acupuncture is a sham".

I didn't say that. Re-read what I said:

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

I didn't say that because they can be referred to using that expression meant that acupuncture is a sham. I said that the title of the article uses the same type of "slogan" that is used for sham medicine. I merely stated that acupuncture is a sham.

As for any placebo effect, that is certainly possible. However, I don't see that as a logic to allow people to sell such a treatment. (I feel the same about homeopathy, which is also a sham.)

Regarding any possible "proven" successes of acupuncture, this blog (http://www.sciencebasedmedicine.org/?cat=8) has a number of articles showing how poor such studies are. For example, this one about acupuncture as a treatment for amblyopia (http://www.sciencebasedmedicine.org/?p=9030) is particularly interesting, and shows how poor studies can end up getting publicized. In fact, the article's conclusion is a nice, concise answer to the question:

"Acupuncture is ultimately a shell game of preliminary unreliable results and misinterpreted non-specific/placebo effects."

[topazg]

I didn't say that. Re-read what I said:

Acupuncture is a sham. "Couldn't hurt, might help?" That's exactly the way sham medicine is sold to people.

Your grasp of language is good enough to be aware that most readers will take the two sentences as tied with some level of reasoning logic. If these really are two totally independent sentences with no intended association, why post them?

Regarding any possible "proven" successes of acupuncture, this blog (http://www.sciencebasedmedicine.org/?cat=8) has a number of articles showing how poor such studies are. For example, this one about acupuncture as a treatment for amblyopia (http://www.sciencebasedmedicine.org/?p=9030) is particularly interesting, and shows how poor studies can end up getting publicized. In fact, the article's conclusion is a nice, concise answer to the question:

"Acupuncture is ultimately a shell game of preliminary unreliable results and misinterpreted non-specific/placebo effects."

Blogs are not science, regardless of whether those authoring it are qualified medical doctors. Most such sites I've found, particularly ones that spend their time referring to pseudoscience and quacks, are as poorly reasoned as the "Homeopathy cures cancer because it made my dog better" brigade. I consider neither of those links particularly convincing, and have a strong suspicion having now done another, slightly more detailed Pubmed search, that they are just as guilty of cherry-picking their null studies as the other side are in advocating papers that find an effect. That's not to say I don't thoroughly approve of an in depth analysis of methodologies and conclusions of papers, as it is absolutely essential in my opinion for the proper progress of science. However, it is equally important to scrutinise papers that agree with your opinion as it is to scrutinise those that don't, and that doesn't appear to be the case on this blog.

Even reviews published in highly rated peer reviewed journals are not above being simply wrong, but they at least have passed a few valid tests of credibility to get there. A blog has virtually zero credibility in the scientific community, and rightly so.

[Magicwand]

i hurt my ankle badly and was limping for 5 years.
i went to korea and had two session of niddle penetrating from one side to other side (ankle), since then i was able to walk straight.

is it a sham?
many doctors could not fix my problem but two 5 min session fixed it 100%.
i was non believer at first but had to give in before the result.

there are many things that you can not explain why it works but many times it is true.

[kirkmc]

A blog has virtually zero credibility in the scientific community, and rightly so.

Actually, the people writing there are very well respected in the medical community. Just because it's a "blog" doesn't mean they're not serious. I think that's a very poor assumption on your part.

[topazg]

A blog has virtually zero credibility in the scientific community, and rightly so.

Actually, the people writing there are very well respected in the medical community. Just because it's a "blog" doesn't mean they're not serious. I think that's a very poor assumption on your part.

If you re-read my post, I never said they aren't serious. Most long term blog writers are, or they would stop. I also did not say that they lacked competence in their field. However, the credibility statements isn't an assumption, it's just the way science works. There are all sorts of controls to make sure that research that is used to inform policy and guidance has passed a few semi-rigorous tests on relevant criteria. For all we know, the article you linked to could have picked one study in the face of 20 other studies published on the same association, and it was the only one that didn't find a statistically significant positive association in a well controlled double-blind environment. They say that's not the case, and anyone is free to take their word for it (I suspect that's not the case too, but the example stands). Science cannot be based on blogs, regardless of the respect the authors have in their particularly environment.

Zero credibility is not the same as "they talk nonsense", or "the content of their blog is wrong". It's a statement that the material they post specifically in their blog has not passed any formal scientific assessment of veracity or accuracy. As a result, it has a very low weight when compared to peer reviewed research ... even when compared to the studies they themselves are criticising. If their view is a better, more completely argued case than the hypothesis put forward in the study, then this is sad, but it is also just life. To increase the weight of their analysis, it should be published as a correspondence in the journal of the original paper, or they should get together and do a formal meta-analysis or literature review and get that published in a peer reviewed journal. For all we know, the content they have written would not pass muster, and there's no way of finding out because anyone can post on a blog.

[HermanHiddema]

What? The fact that it's a sham (which is true), or the fact that sham medicine often uses the "couldn't hurt" argument (which is true as well)?

Well, it's your opinion that it's a sham, which isn't the same as being fact. A lack of evidence for something working doesn't mean it doesn't work, and I'm not aware of a large number of papers showing a null effect - absence of evidence isn't evidence of absent. There are even some (including recent reviews on specific health issues) that actually appear to show a positive effect in practice of acupuncture, though this is outside the field of science that I spend much of my time. I don't believe in it particularly, but I haven't spent a great amount of time looking for its possible effectiveness - however, I don't disbelieve in it for the same reason. You can't prove a negative, but you can systematically and repeatedly demonstrate a null in bigger and better conducted studies until you finally have to conclude there's nothing to look for. That hasn't yet been done for acupuncture as far as I know.

Isn't this putting the burden of evidence in the wrong place? I think that, until acupuncture has been proven effective (beyond the placebo effect) in a sufficient number of controlled double blind studies, the null hypothesis should be: "Acupuncture doesn't work"

But no, the false logic was saying "just because sham medicine and acupuncture can be referred to as couldn't hurt, might help, acupuncture is a sham". If I have a headache, I might drink some water - if I'm dehydrated and that's causing my headache, that will help. If it's something else, it probably won't. However, it probably won't hurt, so "couldn't hurt, might help" could be applied to that drink of water - does that make water helping with headaches a sham too?

I didn't read Kirk's post that way, but I guess you could read it that way. To me, he seemed to be making two statements, without saying that one implied the other.

[kirkmc]

[quote="HermanHiddema"]
Isn't this putting the burden of evidence in the wrong place? I think that, until acupuncture has been proven effective (beyond the placebo effect) in a sufficient number of controlled double blind studies, the null hypothesis should be: "Acupuncture doesn't work"
[quote]

Of course. This is the case for any medication/therapy/technique/cure/etc. Just because people believe it works doesn't mean it works (in part because of placebo, in part because, in many if not most cases, the body heals itself anyway).

BTW, just because I posted a link to a blog and an article doesn't mean that _only_ bloggers contest the value of acupuncture. I think it's obvious that they are just representative of the general medical opinion (though if you get your medical information from Oprah, it may be skewed in the other direction).

[topazg]

Isn't this putting the burden of evidence in the wrong place? I think that, until acupuncture has been proven effective (beyond the placebo effect) in a sufficient number of controlled double blind studies, the null hypothesis should be: "Acupuncture doesn't work"

No, as there's no burden of evidence required. You are correct that this is the null hypothesis, and for it to be "true" then yes, the burden of evidence is on demonstrating it (or rather, consistently demonstrating the falseness of the positive hypothesis). Stating explicitly that something doesn't work does need a body of evidence failing to demonstrate that it does work. However, there's a big but semantically important difference between "it doesn't work", and "there's no strong evidence that it does work". The latter requires no burden of evidence, and it needs to be shown to be incorrect by the burden of evidence on the other side before such treatments should be brought into clinical practice.

In practice then, without good evidence, people can choose to use it or not, but I don't believe that clinical practices should employ it as a technique when they have better supported methods that they can use instead. If the scientific literature is suddenly filled with papers demonstrating the efficacy of acupuncture, then its use can be reassessed, until then "no good evidence that it works" is enough to not use it. However, if you want to make statements like "it doesn't work", or "it's a sham", then you choose to take the burden of evidence onto yourself to support it, as you've made a definitive statement just as strong as "it does work".

But no, the false logic was saying "just because sham medicine and acupuncture can be referred to as couldn't hurt, might help, acupuncture is a sham". If I have a headache, I might drink some water - if I'm dehydrated and that's causing my headache, that will help. If it's something else, it probably won't. However, it probably won't hurt, so "couldn't hurt, might help" could be applied to that drink of water - does that make water helping with headaches a sham too?

I didn't read Kirk's post that way, but I guess you could read it that way. To me, he seemed to be making two statements, without saying that one implied the other.

Fair enough, I'm happy with the possibility that I was in the minority (maybe even a minority of 1) for misinterpreting it