Of Needles and Dentistry

Last month the BBC news website published an article about recent research on the use of acupuncture in treating phobias, particularly dental phobia – a fear of going to the dentist’s.

The research was published in the international peer-reviewed journal Acupuncture in Medicine, and was carried out by eight dentists, including the research leader Dr Palle Rosted. It involved twenty people, each of whom spent five minutes recieving treatment in the chair prior to their check-up, with needles placed at two specific acupuncture points on their head reputed to aid relaxation(for those who care, the points were GV20 and EX6). The patients were asked to rate how anxious they felt before and after the acupuncture using a scale known as the Beck Anxiety Inventory (how much of an experimental Beck album you can listen to before you start to prefer going to the dentist’s). Scores on the BIA typically fell from 26.5 to 11.5 after the acupuncture.

All patients were in their forties, and had had the phobia for between two and thirty years. Many had tried other methods, including hypnosis and relaxation techniques, but none had apparently worked for them. I have to wonder whether these were done right before the check-up like the acupuncture was? It seems to me that this could make all the difference in drawing a qualified conclusion.

The small sample size is also a problem, although Dr Rosted does acknowledge this:

“Although it’s a small number of patients that we’ve looked at, all of the patients benefited. These were patients who would have previously run screaming out of the door or would have to have been held down by a dental assistant to have their teeth checked.”

Bloody hell, I’d be scared of the dentist’s if they forcibly held me down!

The big problem for me here apart from the small sample size is the reliability of the patients’ self-assessment. Simply asking them how they felt doesn’t seem to me to be solid enough as evidence. However, all twenty patients were apparently able to go through with the check-up following the acupuncture and I don’t think it would be unskeptical to accept the researchers’ claims that bigger studies are now warranted. If something is potentially going on here other than placebo, we need to attempt to know for sure, even if it’s just to rule it out.

What I would like to know is over how many years this study was carried out, and how many visits it covered. To emphasise how badly the patients suffered from their phobia, the report points out that on dentist visits prior to the study, three of the patients had to be knocked out with general anaesthetic, six needed strong sedatives, and on fourteen occasions treatment had to be cancelled because the patient could not go through with it. What we don’t hear is how many times it wasn’t cancelled. Maybe some of these patients had successfully visited the dentist more often than they’d had to leave. Maybe all fourteen cancellations were the same person. Also, was the treatment on each of these occasions different? Were they all just check-ups or did they involve fillings or other more intrusive procedures: there’s a big difference between a metal stick in your mouth and a drill. Other small but important facts we need to know are whether the cancellations were early visits or later ones. The patients may have chickened out the first few times, but made many subsequent successful visits since. We are not being given enough information to make a realistic judgement.

The news report claims that Dr Rosted denies the results were due to the placebo effect, and that the acupuncture was ‘doing something’. It also claims that Rosted says that anecdotal evidence suggests acupuncture could help even when patients need more complex treatments like extractions or fillings, not just check-ups. Although it may not be suitable for those who also have a fear of needles!! 

Silliness aside, the news report doesn’t present Rosted as the most scientifically minded person. However, on researching various reports on the same story I quickly realised that not once anywhere is there a direct quote from Dr Rosted putting forth these more debatable claims, and I suspect that this is probably a case of journalistic misrepresentation and that Dr Rosted has actually done nothing more than conduct a reasonable study in a reasonable manner. The woo in this article seems to be wafting from the journalist’s direction. It’s worth pointing out that it is Rosted himself who says that more study is needed, too.

Ah, journalism, where did you go?

Researchers are now planning a randomised controlled trial with more patients to test the therapy against sham acupuncture. I for one welcome any attempt to further our knowledge. It is the only way you can excise bunk from medicine and science. Personally, I’m not convinced there’s anything to acupuncture beyond placebo, and I think there’s some wishful thinking going on here, but these kind of trials need to be done. Researchers’ jobs would be a lot easier though if it wasn’t for needlessly subjective and suggestive ‘journalism’ such as this. But that’s a rant for another day.

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  1. #1 by Stu on April 19, 2010 - 11:42

    Hmm. I don’t know. As a hardened sceptic/atheist fundamentalist I really don’t like woo.

    However a friend of mine, along with quite a few others, recently stopped smoking through acu. Maybe it is placebo but dozens of people were involved and are recommending it to everybody else. I haven’t spoken to the others but will be asking for feedback from as many as I can.

    From what I’ve been told so far though, if it’s placebo then it must be a mass halucination.

  2. #2 by Mathew Partridge on April 19, 2010 - 21:32

    @Stu Are you serious with that comment?

    If you are serious then you need to realise your statement has more holes in it than the crusty gusset of an old man’s tightey whiteys.

    Off the top of my head;

    Ad Populum
    Anecdotal evidence
    Biased Sample

    How about you look at the people it has worked for along with the people it hasn’t? Also track the success rates vs failures and take into account the drop out rates. While your at at it why don’t you look at a method to employ a double blind system with this mini pseudo-study of yours? Also I suggest you read up on what the placebo can do and how it is affected by expectations and personal recommendation either from someone in a position of trust or authority. Also this friend of yours, did they know the people in the group? If that is the case then you also need to take into account the way in which behaviours can be reinforced by a social groups. Accupuncture Fag Watchers Anonymous?
    Also how are you defining success in this group of fag free pin cushions, no cigarettes for what, 1 day, 3, forever (you did say recently)? Are there any other interventions such as nicotine replacement patches, aversion therapy, sugar free lollipops, inhalators or even evil cigarette smoking wombats?

    *face palm* Seriously?

    *Goes to bed*……….

  3. #3 by Mike on April 19, 2010 - 22:10

    This seems like a really poor trial. As you say, there’s a fairly small sample size and the self-assessment problem, but there’s also no control group, and so no blinding either. From the description of the trial it seems pretty clear to me that the patients would know what they were trying to measure, seeing as they were asked to rate their discomfort on the BAI twice, once before and one after, and they just happen to have a phobia. The potential for placebo here is huge.

  4. #4 by Stu on April 20, 2010 - 17:10

    I wasn’t completely serious (never am unless the subject of psychics comes up(!!)), I’ve since spoken the friend and she’s still not smoking. However, most of the people she put on to the stuff started again more or less immediately after the spikes were taken out.

    I’ve had a look around though and, as Colin says in the post, it would seem there’s a need for further investigation on the subject. Most trials have reached the same conclusion but they don’t seem to have been followed up.

    Have a look at http://www.ncbi.nlm.nih.gov/pubmed/18525459, an abstract of a review of trials already carried out. It neither confirms nor denies the efficacy of acu.

    My straw poll at lunchtime does, however, indicate it’s a pile of shite!

  5. #5 by mathew partridge on April 20, 2010 - 21:57

    Comments withdrawn.

    I’m off to consider why the best analogy for a weak argument involved old men’s crusty underwear and how that could be a worrying insight into my Psyche


  6. #6 by Stu on April 21, 2010 - 09:01

    Haha! Nice one Mat.

    Ah well, at least in sparked a BIT of debate.

    I’ve done a bit more googling, sorry research, and come to the conclusion that every trial carried out is as poor as the one that sparked the post in the first place! As Mike points out the potential for placebo is huge.

    Wish I could stop smoking. I’ll have to try hypnotism now. What would your thoughts be Mat?

(will not be published)