Health News Review: Wrong on Crislip and acupuncture

Health News Review: Wrong on Crislip and acupuncture

Health News Review, an organization devoted to deconstructing news reports on healthcare, just issued a critique of a story on dry needling published by USA Today. While the review was generally on the mark, two statements stuck out that beg for correction.

As USA Today explained, acupuncturists say dry needling is really acupuncture by another name, while physical therapists say it is not. As dry needling involves sticking thin needles into muscles and connective tissue with the goal of reducing pain, one can see that the acupuncturists have a point. On the other hand, physical therapists say, dry needling invokes none of the fantasy of qi flowing through meridians as a supposed mechanism of action, and they have a point too. Those squabbles aside, what does the evidence say?

Health News Review gave USA Today 4 out of 5 stars for its story, noting that it correctly reported the lack of evidence of effectiveness and the risks of dry needling, although it failed to discuss quantified benefits, "such as how much pain relief people report in the studies, or for how long."

Hard to quibble with that. But here's where the reviewers go wrong:

"We would have liked if the story had gone a step further and delved into the actual science behind dry needling and acupuncture more deeply, and if some of the interviews with people with vested interests had been exchanged for interviews with pain management experts who don't have a predisposition for or against the procedure. There is enough evidence on acupuncture as a therapy to have persuaded at least some states to create medical licensure programs for its practice, and the story touches at the very end on the idea that there is a training component here that needs further exploration."

And who is one of those singled out by Health News Review as having, as they call it, a "potential conflict of interest?" Our very own Mark Crislip:

"Mark Crislip writes for Science-Based Medicine — as the story notes 'a website critical of alternative medicine' — and generally is quite skeptical of alternative therapies like dry needling."

Since when is skepticism of alternative therapies a potential conflict of interest? Let's take out our dictionaries and give this a closer reading. "Alternative medicine" is by definition lacking in evidence of effectiveness. If a treatment has adequate evidence of safety and effectiveness, it's called "medicine." It is also, by definition, used in lieu of "conventional medicine." "Skeptical" means "having an attitude of doubt" or "doubtful." A "conflict of interest" occurs when one's personal interests "might benefit from his or her official actions or influence." So, Dr. Crislip's being doubtful about treatments with no evidence of effectiveness used in place of treatments with evidence of safety and effectiveness potentially benefits his personal interests? How?

Giving Health News Review's reviewers the benefit of the doubt here, I have to suspect that they aren't actually that sloppy. Surely they are aware that none of us who write for Science-Based Medicine has ever gotten a penny for what we do. And I know they are too smart to fall for the Big Pharma Shill gambit. What I imagine they meant was that Dr. Crislip and the rest of us at Science-Based Medicine are somehow biased against alternative medicine.They're wrong there too. In fact, we do pretty much the same thing as Health News Review, which describes itself thusly:

"HealthNewsReview.org evaluates health care journalism, advertising, marketing, public relations and other messages that may influence consumers and provides criteria that consumers can use to evaluate these messages themselves. Improving the quality and flow of health care news and information to consumers can be a significant step towards meaningful health care reform."

In his very first post on SBM, founder Steve Novella criticized a New York Times report on an herbal remedy in much the same fashion as Health News Review does here:

"It is critical for effective health care and consumer protection that practitioners, educators, the industry, and regulations focus on that which is important – evidence for safety and effectiveness."

That's what we've been doing ever since. While our focus goes beyond press releases and media reports, we are both out for the same result: helping consumers navigate health care information by providing criteria they can use to evaluate its content. The fact that we often, though not exclusively, critique alternative/complementary/integrative health care doesn't mean we're biased. It simply reflects the many ways in which that particular category of health care misinforms the consumer and fails to stand up to scientific scrutiny.

Health News Review's second error (actually, three errors in one) claims there is enough evidence for acupuncture that some states have created "medical licensure programs for its practice." First, there is no good evidence that acupuncture is effective for anything. Cite whatever source you are using for this statement and we'll tell you why it's faulty. (You do have a source, right?) Second, it's more than "some states" if by "medical licensure programs" you mean licensing acupuncturists as health care practitioners. Kansas just became the 46th state to pass an acupuncture practice act. Third, and more importantly, please disabuse yourself of the notion that scientific evidence has anything whatsoever to do with state licensing of alternative health care practitioners, acupuncturists or otherwise. It doesn't, any more than states' requiring the teaching of creationism has anything to do with science. (I recommend you go to the Science-Based Medicine website and review my posts on Legislative Alchemy.)

I have been, and remain, a fan of Health News Review, and still look forward to its weekly emails. I think I speak for all of us at Society for Science-Based Medicine, and those of us who write for the Science-Based Medicine blog, in saying that we share your goal of improving health care journalism. But our criticism of implausible and unproven health care practices is no more evidence of bias or a "potential conflict of interest" than your criticism of the reporters who credulously regurgitate press releases. We should all be on the same page here. 

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