I’m Adrian Larsen, I’m really
excited to have you all here. I’m going to just jump right in I’ve got a bit of a presentation
prepared so, here we go, we’ll
get into that. Today’s presentation, I’ve called it,
‘Seeing is Believing -Proof, Placebo and
Powerful Marketing’ How many of you have
dealt with the problem of placebo in acupuncture? What? Why are we talking
about placebo? Well, the deal is, this presentation really is
about marketing. But we’ve got to think about marketing from a new perspective. And so,
we’re gonna start with some science, and we’re going to talk about a little bit of
controversy. And then, we’re gonna get some new approaches in our heads for
how we can better interface with our patients, get better results, and run
a more successful practice. How many of you have heard
these accusations though? Acupuncture is just a placebo. If you… If you would just throw in a little comment, if you’ve ever run up against that, I’m just curious if this is as widespread as
I think it is because I see this all the time, “oh you’re not really doing
anything, it’s all just pretend.” And it’s not surprising you know, I googled acupuncture
placebo, that’s what I typed in and Google did us the favor, instead
of just the normal results that you get, they have what they call a little featured
snippet. And here’s the snippet that they feature, number one result, if
you google acupuncture placebo, what you get is this, ‘If, indeed, sham acupuncture is no different from real acupuncture, the apparent improvement that may be seen after acupuncture
is merely a placebo effect. And that’s from the ‘Acupuncture
Doesn’t Work’ article on a blog called ‘Science-Based Medicine.
So that’s pretty damning and that’s really nice that that’s the number one result. So I went over there and checked out that blog over here at science-based medicine, that sounds pretty official, doesn’t it? Science-based
medicine exploring issues and controversies in
science and medicine. So I checked that out and I noticed that yeah, it’s kind of a hack
ob, a bunch of half-truths and cherry-picking and so on, and I
also noticed that they have a donate button right there, above the fold,
front and center which means that if you explore controversy in science and
medicine, you get traffic and traffic means dollars and this is a way of
generating traffic. So, if you say something outlandish, you can generate a lot of,
shall we say, attention, ‘Donald Trump’. So what about–oh no, here’s another
one, ‘Acupuncture Magic, and Make-Believe.’ This is all as a result
of this Google search I did and look at that, there’s a donate button right
there on the top of the page. Let’s stir up some controversy and get some donations.
Even our good friends at the venerable quack-watch, where the delicensed
Stephan Barrett MD runs his hack show, we accept donations to support our work
right there at the top. So, we’ll just go ahead and dispense with that and let’s
check into what actually can be learned from the science rather than what can be
used to generate controversy. Well, when you try to find out the science and
you Google, you do a little bit of searching around this, you get a bunch of unbiased
acupuncture reporting from the unbiased popular press. And if you believe that one,
then, I’ve got some election results to sell you. ‘Acupuncture Is No Better
Than A Placebo For Treating Back Pain’, says report. These
are all actual headlines from actual news articles in the
popular press. Check this out, ‘Acupuncture Is Theatrical Placebo’, ‘Acupuncture Offers No Benefits Over Placebo For Hot Flashes Of Men.’ Another study shows, ‘Acupuncture Is A A Placebo Treatment’, on and
on it goes. There’s more, ‘Is It A Placebo Therapy?’, ‘It’s all placebo’, ‘Acupuncture myths’, ‘Acupuncture Magic And Make-Believe’, placebo, placebo, placebo. Now, all of these placebo studies,
all of these acupuncture studies that show that
it’s all just a myth, well they’re all based on what
we call sham acupuncture. And any real acupuncture
that’s performed in the study, is almost uniformly performed
at a sub-optimal dose or improperly administered such that the studies are
weighted against getting positive results
for acupuncture. And so that’s important to understand
and realize when you’re considering what you’re going to
believe in the press. This problem of sham
based acupuncture, we will address in a minute.
But let’s first dig into a couple of these reports. Here’s one, that one of these headlines I featured at first, ‘Acupuncture Is No Better Than A Placebo For Treating Back Pain’ says report.
That’s what the headline said. Well, they were assigning a study
done up by Daniel Churkin in 2009 And in this study, a total of
638 volunteers with chronic back pain were randomized into four groups. Group one received individualized
acupuncture, that means that they had an actual
acupuncturist decide what the problem was, make a diagnosis and treat
the pattern that was presenting. Group two was standardized acupuncture,
that means everybody gets the same set of points regardless of what
their presentation is. Group three was simulated acupuncture and that means
that we have a sham non-penetrating needle where we place it over the point,
and we push the needle and you feel a little poke but the skin isn’t broken. And then the fourth is
the usual, which means medical care, in other
words given some pills. And so this is 638 adults, this is a large study, they
put them in these groups, and this is what they came up
with for the results. Collectively, it says these recent trials provide strong and consistent evidence
that real acupuncture needling using a Chinese Meridian system, or in other words real acupuncture,
is no more effective for chronic back pain than the
various purported forms of sham acupuncture. So, they said,
“yeah, you know, put in the fake needles and doing the real
needles, it was all the same and therefore, acupuncture is just make-believe, it’s just placebo.”
And that’s what the press ran with, except what the next sentence says. They kind of ignored that one however, both
real and sham acupuncture appear superior to usual care. What does that mean? Well, here’s the actual graphs
from the study. And if you look, you have the four bars
in each one of these little groupings, you have the individualized
acupuncture, that’s the white bar, and then the darker grey
bar is the standard acupuncture. Everyone gets the same thing. The fake acupuncture is black,
and then popping pills that’s the light gray, you know,
the low bar there. And this is the percentage of participants who had improvement in
their symptoms at 8 weeks, 26 weeks, that’s a six-month marker, and then 52
weeks, a year later. And you can see that all the forms of acupuncture,
roundly trounced the drugs. Acupuncture is a ton
better than drugs and even the fact that they
want to point out that, “hey, sham acupuncture worked”, really, what we ought to be
doing is finding out why does sham acupuncture work, so we
can give it to all these folks that have back pain? Now, there was an update study done. This study is from 2016 actually,
this is fresh off the presses ‘Non-invasive Treatments
For Low Back Pain’, this was done by the agency for Healthcare
Research and Quality, this is a government agency and this was a very large study. Now, the reason they did low back pain is that low back pain is a
massive health problem, $10billion dollars spent per year
in the US on low back pain, generally, not good results
for most treatments. And it is the number one gateway
to opioid addiction. Low back pain is how you
end up on opioids, and opioid addiction as
we all know unfortunately, leads to rather dire
consequences including legal problems, heroin addiction when people can’t
get the opioid opioids anymore, it’s just, it’s a terrible problem and
it’s a terrible thing to do to people, put them on opioids for
low back pain. But that’s what’s going on,
so in this study they looked at all of these treatment
types, and look at this huge list, they looked at everything that people
are doing for low back pain, everything from the drugs to various
physical approaches, various therapies, TENS, PENS, Muscle Stem, Traction,
Taping, Interferential, Laser, all of these therapies. They looked at Exercise,
Tai Chi, Yoga, Physical therapy, or psychological therapies, and
they looked at acupuncture, as well as massage, and manipulation. And then they rated all these things ,
and they rated them on two factors, factor number one
was effectiveness of you know, how are they… how are they effective for
getting out of pain but the other one was effectiveness
for restoring function. It’s one thing to get somebody
out of pain but it’s another thing to get them functional
back to work, back to their life. And (oh whoops, sorry, got a head there) what they found out was
out of all of these approaches to low back pain, there was very, very few
that rated very well at all. The drugs uniformly were terrible, most
of the other things might have been moderately successful or somewhat
successful in eliminating pain but not necessarily in restoring function, etc., acupuncture across the board,
rated the highest. Not only, not only for restoring pain but
also removing pain but also for And so, acupuncture across the board,
any treatment involving acupuncture, trounced any treatment that
did not involve acupuncture. And so, that’s the update to what was done in 2009
when the press was blaring, “hey acupuncture is no better
than sham, it’s fake.” Well, there’s a headache study,
also done in 2009, and this was a course
of eight weeks, patients with acupuncture
had fewer headaches compared to those who were
given only the painkillers. There were two headache
studies, one was migraines and the migraine study acupuncture
was superior to the drug treatments. But then they said, “hey the
fake treatments work too.” And the tension headache
study true acupuncture was slightly more effective. Well, it depends
on how you play with the numbers but acupuncture can be shown to
have a statistically significantly better effect than sham. Well again, here’s the
update for 2016. The Cochrane review
published in June 2016, ‘Acupuncture For Prevention
Of Episodic Migraine’. And just to summarize, when you added acupuncture to
the usual care, which is drugs, you’ve had 41 out of 100 that had their headaches cut in half. Only 17 out of 100 had their headaches
cut in half with just the drugs. The acupuncture was much more
than twice as good as the drugs. Frequency of headaches cut in
half, 50 out of a 100 receiving true acupuncture, 41 out of 100 receiving fake acupuncture,
and that my friends is statistically significant. Real acupuncture actually is better, and if you’re careful about how you
do your statistical analysis you can find that there’s actually
a large effect. It’s easy to hide it though depending on
how you run play with your numbers. And then again at three
months the frequency, six months frequency, you can read it
there. The bottom line is that acupuncture was hands-down,
a lot better than drugs and had fewer reported side effects. Also, people getting acupuncture were
less likely to drop out of the trial. So, here’s the question then, with all
of this evidence, and all of this controversy, and all of the donate
buttons on websites out there, the question is, is it just a placebo? Well, let’s talk about the
other side of the story. First of all, there’s no really effective placebo for acupuncture because there’s
no demonstrated mechanism. I need to talk about that for a minute. When you’re designing a study
and you have to have a placebo, a well-designed placebo is identical in every
way except for the mechanism of action. That means that if I’m doing a drug trial,
my placebo pill needs to look have exactly like my real pill, have exactly the
same packaging, be administered in exactly the same way by exactly the same
sorts of staff wearing the same thing at the same facility talking the same way
in other words everything is identical except that the one pill doesn’t have
the drug in it, it’s just a sugar pill. That way you’ve isolated
the mechanism. Okay, so what’s the mechanism of
acupuncture? How you can isolate it? Is it piercing the skin with a needle? Well, I think we all know that acupuncture doesn’t
have to pierce the skin to be effective. That’s you know, 101 kind
of level stuff. You can do acupressure, you can do electric, you can
do laser, there’s all kinds of different stimulations. So how do you isolate
the mechanism? When they have these sham needles, there’s various approaches
including a needle that pricks or that makes you know, kind of a sharp feeling
on the skin but doesn’t actually pierce. Then, there’s a needle that is only
pressure, it’s not sharp feeling. And then, there’s a needle where
you can’t feel anything, they just tell you there’s a needle in
there, and they stick a sticker bandage thing on there with
a needle sticking out of it. But then, how do you also
blind it to the practitioner? How does the practitioner know if they’re
actually performing acupuncture or not? Because in a double-blind study,
not only does the patient need to not know whether they’re
getting a real treatment but the practitioner needs to not know. That way, you isolate out and remove any practitioner
biased for treating people differently. So, if there’s no demonstrated mechanism,
you can’t differentiate a placebo. And so, you can’t say, “oh well
fake acupuncture is just as good as real acupuncture”, because
you don’t know what real acupuncture is. There’s no way to double-blind. We talked about that both the
patient and the practitioner. So then, what do we do with
all this clinical evidence? If you’re a practitioner, you already
know that acupuncture is effective because you have a big dossier of clients
who’ve gotten better. You’ve got lots of clinical evidence, you’ve seen it in your training,
you’ve seen it in your practice, there’s anecdotal evidence. You hear all kinds of stories, you hear
all you see, all kinds of case studies, and I get that those are
not scientific studies. But, nevertheless, there’s such a large
body of this evidence and dare I say, thousands of years of it compared
to modern medicine which is you know, it’s age, numbers,
and hundreds and barely that. Versus thousands for acupuncture who has more evidence. And then you have the problem
with skeptical patient. How come a patient who thinks that
acupuncture is complete bunk still gets better? If it’s only a placebo effect then, and you’re just getting them better
because they think they’re gonna get better, because you create a belief, what do you do with a skeptical
patient who gets better even when they’re certain they’re going
to not get better? And they do. And what do you do with a positive,
unexpected side effects? You treat somebody for their headache you say,
“yeah, you know, this will help your headache, your head’s gonna feel better.”
And they come back and say, “yeah, my head felt better but you know what you also fixed? I’ve got all this energy or my libido came
back.” Totally, unexpected results that you didn’t tell them to expect,
that can’t be placebo. And of course, you’ve
got the animal studies. How do you tell a horse that
you’re going to feel better because I’m gonna stick these
tiny needles in your back? How do you convince the horse that’s
going to do anything at all and yet the horse is visibly more able to move visibly in less pain? That’s hard to explain a way that it was just a placebo because you convinced
the horse they would feel better. All right, well enough about all that plus most stuff from
the acupuncture perspective, why are we even beating this dead horse? Oh, that’s
a bad thing to say after the last slide. Why are we even
on the topic of placebo? Because there’s a problem. Let’s talk about the placebo problem. To do that, we need to talk a
little bit about medicine. Here’s what’s going on in the
medical world with placebo. First of all, color changes patient response. Did you know pink sugar pills are better stimulants
than any other color? You want blue for your sedatives, you want red for pain relief placebos, they relieve pain better
than any other color placebo. You want yellow for your antidepressants,
green for your anti-anxiety meds, and you want white for your antacids. These colors actually
have better effects. Doesn’t matter what’s in the pill, it
matters what the pill looks like. That’s part of the placebo problem. And then, there’s the presentation issue. Brand-name placebos and flashy packaging
get better results than generic placebos. Expensive ones work
better than cheap ones, and a higher dose of
placebos works better. So, So, 4 sugar pills a day is better
than 2 sugar pills a day. hen, there’s some cultural effects
and this is quite interesting. The geographic location of the trial makes
a difference. Here’s what I mean by that. In order to get a drug approved in the US, you have to
go through the US Food and Drug Administration, the FDA. And you have to prove two things,
you have to prove the drug is safe and you have to prove it is effective. Safe means you don’t kill anybody during
your clinical trials or do major harm. Effective means you beat placebo. And if you can prove those two
things in 2 clinical trials, you’ll get your drug approved. Well, Well, let’s suppose that you
prove that it’s safe, you know, nobody has terrible
problems from taking it but you can’t beat placebo because
you’re conducting a trial in Detroit. There’s nothing saying you can’t do
another trial and this time do it in India, or do it in Japan, or do it in Nigeria, you can go
wherever you want. You just have to have two trials, there’s also no rule about
how many trials you fail at because you’re paying for them and you’re conducting
them and you just submit them when they’re done to the FDA. You just
submit the two good ones. You can conduct a dozen failed trials as long as you get two good ones, that’s what you submit and so, drug companies will go to the country
that has the best results. And in some countries, it’s harder to be
placebo than it is in other countries, and they know this and so drug trials are tailored
based on geography. Also, placebos work 50% better in
children than they do in adults and I think that’s because children more
readily believe what they’re told. You tell the kid that they’re
gonna feel better they are more likely to feel better. Tell the kid that the Easter
Bunny is gonna come, they’ll swear they saw the Easter Bunny. It is the fact that children are far more
credulous when presented with ideas that they can’t see. What’s the
best medicine for a skinned knee? Everybody knows it’s a kiss from
mommy, right? Kiss it, better. So, placebos work better in children than
adults. Clever names work better. Do you think that Sildenafil would sell as well as Viagra? I’d love to have that job. I’d love to be the guy
that comes up with the names for the drugs. Let’s see, we have a drug
for erectile dysfunction. Let’s take Vigor and Niagara, and
we’ll take it into Viagra, it’s virile, that’s why we need the V on there. But if you name it right,
you actually get better results than if you
don’t name it right. All of these ties in to how
effective the drug is. Methods also matter in medicine. So, placebo injections work
better than placebo pills. The more ritual that surrounds the
treatment the better it works. And when studying, I don’t know
traditional types of treatments in various traditional and indigenous
populations. Science generally tends to say, well it’s just the ritual, it’s a
placebo, it creates belief and therefore, the belief is strong medicine you know, because they obviously want
to discount the fact that there might be anything real happening. So, more ritual is better. Surgery, that’s a big ritual. You’re
gonna have people in costumes right? They gotta
wear the masks and the hats and all the clothing. You’re
gonna have it performed on a special stage you’re going to sign a whole lot
of forms. You’re going to go through a whole lot of ritual to have a surgery. And in doing so, there was a study that came out a few years back that showed
fake arthroscopic knee surgeries were as effective as real arthroscopic knee
surgeries in reducing pain and restoring function to the knee because it was the ritual of the surgery. And sham angioplasyt is almost as effective as the real thing. They used to ligate the internal mammary
artery when people had chest pain due to blocked arteries, and they thought
that would improve blood flow to the heart and that was a treatment for
years and years and years. They would go in and ligate that extra artery in there.
Turned out to do nothing for blood flow, absolutely nothing. But it brought about improvement
because people had surgery. So, here’s the problem, all of this though is okay you know, as long as you can beat placebo
with your drug. The problem is placebo has been getting stronger, it’s been getting harder and harder to beat for the drug companies and the drug
companies have to be placebo, or they can’t sell their drugs, and they
could literally spend a billion dollars researching a jug, doing the
studies, doing the clinical trials, just to have it fail in Phase II clinical trials. In fact, there’s
been a 20% increase Phase II clinical trial failures, that
was from 2001 to 2006. So those, numbers are 10
years old now, and yet they saw increasing trial failures
and the failures were due to the fact that they couldn’t be placebo. The sugar
pills were working just as good as the billion-dollar drug. There was an 11 percent increase
in Phase III failures during that same time period. And half of the failures are due
to inability to be placebo. The placebo effect size has in fact,
doubled since the 1980s. So this is a problem. It’s a problem
for the drug companies. Before we talk about why, we need to also mention something
called the Nocebo effect. You heard of that one before? The Nocebo effect? This is the opposite of placebo, this is
if you expect a negative outcome, guess what? You’re going to get a negative outcome. And similarly, if you tell people to expect side
effects and tell them what the side effects are, they will get the side effects. My favorite example of this is you know, one time I was in
my garage and I picked up a box from off a shelf, and when I picked up the box, I had my
hand underneath it and I carried it over to set it down, walked across the garage holding
this box with my hand underneath it and under my thumb, I felt something. And here I will… I will jump up here so you can see me.
So, right here as I’m holding the box I feel a little bump or something right there on the
bottom of the box, and I’m going, what is that? And it was kind of weird, and
cold, and smooth and so, I set the Box down and it wasn’t a
flat bottom box. It was actually one of those plastic tubs, had feet on it. So, when
I set it down, whatever was under there was still there. So I turned the Box
on its side and it was a great big, fat, black widow spider. And I had that spider right there under my thumb, not crushed, the spider was alive,
and well, which is not, not good, and had been on my thumb
as I’d walked across the garage. And I started to get a little freaked
out and I thought, “ahh no, I’ve got a black widow
bite on my thumb.” flashing through my head is all the
pictures I’ve seen on Google of these Then, flashing through my head is all the
pictures I’ve seen on Google of these spider bites and it’s horrible, and the pain,
and then my thumb started to go numb, and I thought, “oh crap I got bit.” And,
so I’m looking and I’m trying to find, are there any marks? Is there…
No, the skin is not broken at all, there is nothing I can see and yet my thumb starts to hurt. And I’m you know, starting
to almost panic a little bit. Well, I took a few deep breaths,
I waited, I watched, nothing ever got swollen,
nothing ever got too painful, pretty soon the numbness
and the stuff went away, and I was fine. I had not been bitten by the Black Widow. But the Nocebo effect from
being afraid I had been bitten, was enough to actually
cause symptoms. What do you think of that? I was actually surprised at how easily
I could cause my own symptoms by thinking I was going
to have symptoms. So that’s the nocebo effect. And we have to keep that in
mind when we’re talking about all of how placebo ties into what we do in our practice.
So, here’s the actual problem that you and I as acupuncturists
need to talk about. Placebo has become the enemy. You remember I started our
conversation today and I said how many of you have been exposed to the accusation that acupuncture is nothing
more than a placebo? Right? Well, it’s like it’s a bad thing,
it’s like it’s the enemy, it’s name-calling, it’s what it is. If
I call it a placebo, then, I can immediately
remove any validity, remove any chance that anyone
will take it seriously because everybody knows that any serious
medical scientist would never consider that silly foolishness of acupuncture because that’s
just a placebo. It’s a way of dismissing the whole industry lock, stock, and barrel. Why should placebo be the bad word though?
Why should it become the enemy? And how did it become the enemy? Well, let’s talk about how that happened because that’s gonna tie directly
into how you and I practice. We are actually getting to the acupuncture
part of the presentation here soon. So what do you think? Who
wants some cocaine tooth, the toothache drops here, instant cure, I bet. I bet that’ll cure your toothache.
Well in 1985, after a long ban on direct to consumer
advertising, kind of caused by problems like the one I’m illustrating here. In 1985, the FDA lifted
the ban, relaxed the rules, and started to allow
direct-to-consumer drug advertising, and they loosened the requirements
further in 1997. And that made it possible for the drug companies to start advertising
directly to consumers rather than just advertising to doctors. Now, back in the heyday, if they could only advertise
to doctors, they would spend lavishly on doctors, and you know
fly them to resorts to teach them about the drug, and send
them on vacation, and buy them expensive gifts, and all of that stuff. That
went on to convince the doctor to prescribe the drug because the
doctor is the gatekeeper. But when they found out they could
advertise direct to the consumer, well that changed everything, didn’t it? How many of you remember
the little purple pill and all the ads that were going on for the little purple
pill? Just one little purple pill cured my symptoms and the ads showed
people with a happy life, doing happy things that I wish I could do. Look, you know, flying
the kite in the park with their grand kids, and oh here’s a guy driving a
racecar, and they’re all taking the little purple pill. Maybe I need
the little purple pill, ask your doctor if the little
purple pill is right for you. Well, they never said what the
little purple pill did. They just said you needed it, look
at all these happy people to take it and it’s purple,
I mean it’s cute come on. They started to convince people they needed
drugs whether they needed them or not. The ads always focused on positive
visual images, has that changed? Well, of course not, look at any drug ad today. While they’re doing the voice-over of side effects may include nausea, vomiting, headache, massive
fatal nose warts, loss of limb function, and death while they’re doing that you
know the voice-over talk of all the side effects, they’re showing people having a
wonderful time at a picnic with their family, and oh look, it’s grandma’s
birthday, and she can blow out candles, and oh, and this couples
in love, it’s so delightful. Well, the direct-to-consumer
advertising in 1990. When it was first becoming
legal and acceptable, $47 million was spent advertising
directly to the consumers, not for the asthma cigarettes. By
the way look at that, look at that ad there for the asthma cigarettes. Effectively treats asthma,
hay fever, foul breath, all diseases of the throat, head, colds,
canker sores, bronchial irritations but it is not recommended for children under 6. You
have to be at least 6 to smoke these. All right, anyway, 1990 $47million spent on drug advertising direct-to-consume In
2007, that number was 5 billion. That’s a hundredfold increase folks because it works, it flat works. You tell the consumers they need a little purple pill
to have a happy life like the people in the ad, you get a 5 to 1 return on your investment. You spend a million dollars advertising,
you make 5 million dollars in sales. (Whoo) how would you like a 5
to 1 return on your investments? That is incredible! It’s a
license to print money. And so, obviously, direct the consumer
marketing has become huge. You see it in magazines, television, radio, and of course,
it’s rampant all over the Internet. Well, the byproduct of this is they have
completely ruined placebo. Because now, instead of having
to go to the doctor to get recommendations for what you need, you get your recommendations
off the TV or off a Facebook ad that’s telling you that if you
take this drug you’re going to feel better and have all
these wonderful results. Because of that, peep have such high expectations of drugs, they’ve
marketed them too well. All of the happy people in
the ads, look so wonderful that you shove a pill in just about
anybody’s face, and they’re gonna feel better, they’re convinced.
They’ll feel better because advertising is so good. Well, the advertising is destroyed placebo. Visual images are the problem, but they are also the power. All of these visual images that
they use in the advertising, they speak to people, and
they stick in our heads. Even blind people use the visual
processing centers of their brain for certain functions, like
solving math problems. They see it in their head
even if they can’t see. You and I see things in our head. How many of you have ever said, oh I’m
a visual person, I have to see things? Probably, a great majority
of us are that way. And, And, having smartphones in
our hands all the time, having instant information at our fingertips
all the time with the Internet just makes us even more visual and
makes our attention span shorter. And so, it’s very easy to show a few positive
images associated with a drug and now I associate positive images with drugs. See as humans, we’re wired
for belief and for faith. We are people of faith,
that’s how we function. Right now you can’t see anything outside what is
in front of you, but you believe it exists. I know I believe my car is
sitting out in the parking lot. I believe that when I was
driving to work today, the low tire pressure light came on and I’m
gonna have to go get my tires checked this afternoon. Probably, because it froze last
night and the weather got cold. I can’t see any of that in
front of me right now but I can clearly see it in my head
because my brain is wired for that. We are beings that are wired
for belief and because of that, that’s how we act, when you tap into that circuit, it is powerful. And the drug
companies know that. So how do we bring that power to acupuncture? Now, that
we’ve got it in our heads what placebo is capable of doing and
what a tremendous problem it is for the drug companies. Well, we’ve got to be careful about our visuals. I don’t know what this treatment is
supposed to be doing for this gentleman but that is not the visual you want people
to associate with acupuncture. Unfortunately, that kind of is the visual that a lot
of our patients associate with it. They think they’re gonna get needles
in their face, and they think it’s gonna hurt and it’s going to be terrible. The optics really matter. What patients see is going to determine their outcomes,
far more than we’re willing to admit. And so, this word placebo gets thrown
around as if it’s some sort of a derogatory term when really we ought to be embracing it. We ought to be saying,
wait a minute, you mean placebo, you’re calling acupuncture
a placebo and saying it’s 50 percent better than drugs? How do I get me more of that? How do I get me more placebo? Well, what can your patients
actually see? That’s the question. They can’t see their pulse, you can take their pulses
all day long and tell them what you feel, and it’s ritual, and that’s great
but in the end there’s nothing. No convincing image for them
other than how convincing you are. And some of us are really great at selling ourselves and
being convincing and charismatic, and some of us are not. What about tongue? Patient can’t
really see the tongue even if they look in the mirror. They’re
not gonna see what you see. You can’t see acupuncture meridians and you can’t see acupuncture points. As much as we know, they’re there and
as much as we know they’re effective. You’re not gonna go dissect somebody
and dissect out an acupuncture meridian. You can’t see Qi. As much as we know it’s there. And even with great results, even if you know patients come to you
and their symptoms improve a ton, if they don’t have something to
hang it on as to why it works well, we’re back to the question
of mechanism, aren’t we? We’re back to the question of, is this
just magic? Is the just voodoo? We have to know. Not that I have anything against
magic or voodoo, I’m just saying the more we can see, because we’re
visual beings, the better off we are. Well, let’s put the placebo myth to bed and then let’s talk about how to apply
some of these principles into our practice. This is some information I presented a couple years ago, I presented it
almost three years ago and I thought it would be
worth revisiting again. In our research database, as
of 2014 we had 350,000 distinct graphs from nearly 3,000 different
practitioners. So we have a lot of data from which we
can do statistical analysis, and we did a bunch of analyses
a few years back. We looked at acupuncture meridian graphs
for different genders, and we saw, look at that there’s a big
difference between male and female. We looked at upper and lower or hand in foot
meridians for male and female, found differences. We looked at upper and
lower meridian balances for male and female. We looked at left and right balances, which by the way we found are the
same between men and women. We looked at the balance
between Yin and Yang, we looked at skin conductance
for age for men and women, we grouped meridians by age,
group for men we grouped meridians by age group for women. We looked at PIE score over the course
of several visits and found that it improves in a statistically significant
way over the course of several visits. So, in other words, when patients come in for care,
their PIE score tends to improve, which puts some validity to the idea
that no, this is not just some non-existent imaginary effect, but it’s statistically
significant. And this is not a self-reported thing like you know
on a scale of one to 10, how’s your headache today?–Oh, it’s about a four.
And you know it’s not a subjective scale, this is objective, durable evidence. We also looked at the PIE score by gender and found that for
both genders it improves. We looked at the stability score, we looked at it by number of treatments
and broke it out into age groups, and we looked at it by gender, and we found that again, stability
score improves across visits, That’s not something you can fake because
this is an objective measurement. This is like taking a blood test
and seeing, oh yeah you know, your cholesterol number is down or whatever number you’re trying to
improve, it’s not subjective at all. We looked at Yin versus Yang balance, we
grouped it by age, we grouped it by gender, we looked at splits, and we did the same thing, the number of splits
across the number of visits and found that on both genders, the number
of splits decreased in a a statistically significant way across visits. And so, all
of these parameters showed improvement over the course of five
visits. The PIE score, the stability score, the Yin versus Yang balance, the number of splits. Because of that, it’s very hard to convince me that
acupuncture is just a placebo. How can you get people to change their physiological numbers as measured electronically, just by telling them that your head’s going to feel better or I’m creating
your symptoms, whatever they are? This is real, these are real effects. People
actually do change and improve. So, is acupuncture really
nothing more than a placebo? No, acupuncture is not just a placebo. And remember these are not subjective estimates,
these are objective measurements. So, the conclusions that we drew that the acupuncture meridians have measurable electrical
properties, in other words, they are real. The properties, they differ significantly by demographic, age, and gender, for example. They do change with acupuncture
treatment tending toward more balanced You can’t attribute those types
of changes to placebo effect. And the greater balanced correlates
with improved clinical outcomes. Acupuncture is real, it is not a placebo. The Sham isn’t acupuncture, the Sham is the inability to isolate the
mechanism and so you come up with a fake mechanism. You set up a straw
man argument and you pretend that you’ve disproven acupuncture, and then it makes for great controversy, and
you can get some website traffic with that, but it’s not honest. We, by the way, this research, we submitted this to the International Scientific Acupuncture
Meridian Symposium in 2011, we did not know it was a contest, we just submitted it
because we wanted to share it, we ended up winning top prize for that, for this, these study results that we did. But that’s not the point. The point of all this discussion of placebo
and discussion of acupuncture is how to help your patients see the Qi and how to use that in your practice to get the results you want not, only for clinical
outcomes but for marketing outcomes. So, of course, we’ve got graphs, we’ve got methods to show people
what’s going on, and we’ve got all kinds of different graphs as an AcuGraph
user, you’ve seen all of these. Perhaps, you’re using some and hopefully,
all of these as communication tools to convey to your patient exactly
what’s happening. Don’t forget this written report is every bit as
important and every bit as visual as all of those other visual graphs are. And why does visual matter? Well, remember what we talked about
how people process, how people think, we think in terms of pictures, and we think in terms of outcomes for ourselves.
We picture ourselves. The reason those drug company
ads are so successful is we can all picture ourselves being those
happy people in the drug ads. You’ll notice that those people in the drug
ads, they always are smiling, they’re they’re always doing something enjoyable, they always look real but
not too real. You know they’re fit, they’re trim, even if they’re older they look healthy,
active older people. They are an idealized image,
they are models, and we can all picture ourselves
that’s why it works. So even in comparisons, (oops) even in comparisons
we need to use the innate ability to visualize, to help our patients understand and comprehend that yes they are
improving, yes this is making a difference, you actually have improved
balanced scores, that matters to the outcome. Similarly, you have tools in AcuGraph that help you communicate what the
meridians are, where they run, how they can be used, you can tie that in
not only with meridians but with points. You can use the musculo-tendino channels, you can use the internal branches, all of these tools are
available to you as an AcuGraph user. We made AcuGraph with the number one
purpose of being extraordinarily visual. If there’s something to be communicated,
we want patients to see it, not just be told it. So, if they can see a real-time snapshot
of the meridian balance, if they an see an explanation for why they have
the symptoms, and why is the number one question patients have, when they’ve been all over the
place, they’ve been to other doctors, they’ve been to other
practitioners, they haven’t gotten results, then they haven’t gotten
answers. If you can tell them why they have the problem that’s half the battle as in, good news, I know what’s wrong. They’re saying, “well, thank God, somebody
finally knows what’s wrong because I’ve been you know, eight other places,
and they all think I’m crazy.” Or they, none of, nobody tell… knows
what’s wrong, nobody can tell me. It gives patients the expectation of great
results. When you can show them then, they’re going to expect to feel better, and it shows the degree of change, which also ties directly back into the
belief circuit and helps them understand that they’re going to feel better. So, what happens when you do that? Well, you do, you get better treatment results
because you’re combining their belief not just ritual not just doing acupuncture
but explaining acupuncture. This results in both loyalty and primacy.
Loyalty means they’re going to come back, they’re going to follow your
recommendations, they’re going to follow your treatment plan. Primacy means they’re going to think of acupuncture
first, instead of as a last resort. And we’ve all been there, where the patient comes to us as a last resort because
they’ve tried everything else and nothing works. We want
them to come first in fact, we want them to come once a month for
a tune-up or once a quarter when the seasons change just to keep themselves
at their tip-top health. And that’s what you find out when you’ve tied into this circuitry
into this psychology and of course, it’s unparalleled
for marketing. I believe we’ve held seminars on this, we’ve done trainings on it, we’ve talked
about this, and we know that if you go out there you set up a booth, you do a
show, you will have people lined up to get their graph done, and that invariably results in, getting more patient visits, getting new patients to come to your
practice and try acupuncture for the first time because they can finally see it. So, some take-home points that I would
like all of us to keep in mind from this presentation. First of all, it is hard to beat placebo. Now, the drug
companies when they say beat placebo, they’re talking about beating
it into the ground. They’re talking about we have to be better than
placebo, or we lose a billion dollars and the stockholders don’t like that and
the board has to oust the CEO. So, they have to beat placebo
as a negative. But I say you know what? It’s hard to beat placebo. Why not embrace patient belief? Why not
use all the power of the human mind and all the power of the human belief
system to get the best results we can? We already know we’re doing real
medicine, we already know we’re doing real good, and we’ve got the proof so why not embrace everything
that goes with it? You can’t beat it, use it. Visual tools are your best
possible marketing and for those of us, I assume almost
all of us here own AcuGraph and so, I want to remind you to be
using it for your marketing. And marketing is an ongoing process even
with existing patients. Don’t forget to give them something visual even on every
visit, just show them again, reinforce the notion, reinforce why they
come to see you. And well, yeah, AcuGraph,
there you go. Here’s my challenge to you then, during the presentation today, I’m thinking, I’m hoping anyway that you learned something new,
that there was some point that you thought, “hey you know, I could do that in my practice. I’m not doing the before and after comparisons like maybe
I should.” Or, “I’m not using the printed report and sending it home and asking
them to circle or highlight every problem or symptom that they’ve
had in the last, say two months,” if you do that, send it home with them, have them go through the report
and bring it back next visit, it will be eye-opening for
you and for them. If you’re not using the
different graph types, or if you’re not tying in
the meridian pictures to the location of the symptoms, here are a number of ways that
you can be getting more out of your AcuGraph investment
in your practice. If you’re not going out, doing
marketing events whether you’re doing a health fair or a
show, public speaking engagement, whatever it may be, if you need patients, that is hands-down, the best way to go
get new patients is use the power of visual belief. So, I wanted to remind you and I
wanted to challenge you right now, write down one thing hat you learned, that you could
be doing better so that you can have a more
successful practice. And my challenge to you is start now and implement it. Start doing it next week on Monday when you have
patients come in, do something differently, keep changing it up, see what improves. Now, I have a really cool announcement, something I’m excited
to share and you folks are going to be the first people that do not work for
Miridia technology that are even going to become aware of this today. But
before we get into that, I wanted to just jump in take a quick look see what we can do if there are questions
that need to be answered. I do see some questions here. Interesting. So Arlen talks about
how they don’t disclose what the placebos are. Marty says, “the Sham heart surgery not
only relieved the angina pain but it improved heart function as well as
the real surgery, isn’t that exciting?” What else do we have? Marty, “I agree
AcuGraph charts help make the effects of acupuncture more tangible and real even
if they feel the benefit, they believe it more when they see the benefit.”
–Yes, absolutely. Daniel says, “I’m an acupuncturist for 36
years and AcuGrapg is the best to live.” Oh, thank you, I appreciate that very much.
Marty, “embraced patient belief that’s the essence.” Yeah, cool. You guys are getting
it. Any other questions that we want to throw out there, go ahead and throw those questions
out there now. And Kimberly if you have anything to chime in before we
move on to other stuff… I thought that coming at this from the placebo angle
was just really fascinating at least for me, the way my mind works, that is just so cool to see so that’s why I put
this presentation together today. But anybody else have
anything to throw in? Anything Kim? –I’m, yes. One of my favorite things
about AcuGraph is if I have that patient who doubts, I remember early on in
my career, I’d have family members who would say, “oh yeah, I don’t believe in
that.” And I would think to myself, you don’t believe, it has nothing to do with
whether you believe in it or not but when you have a patient who comes in,
and they have that mentality of I don’t believe in acupuncture but then you
do an exam, where you’re measuring electrical skin resistance and showing them on a computer screen and what you see on the computer screen matches with
their symptoms, then their eyes just get big, and they get excited. And then the
other thing is when you have that other person who wants to believe, they come in,
and they’re wanting to believe and then you graph them and you show that
everything that they are complaining about makes sense in one report then,
they just take this big sigh of relief because you are the one to be able to
fix them, and they leave believing and knowing, and sure that you’re going to
fix them. And I love that. If that’s placebo and that helps
me in my clinic, I’ll take it. –Amen. Let me ask you this Kimberly, just curious.
You know, when you show them the report, you talk about the symptoms, I
know what’s wrong with you, I can help, do you ever have the tears? You ever have
patients just break down because you’re the first person that’s told them that? –Absolutely, I get tears from my patients all the time. I remember,
I mean, often times, yes, just by treating what I see in the graph and with the analysis, I’ll get
tears through the graph and then I’ll get tears when they’re laying on the
table not because I hurt them but because someone finally
relieved their pain. If the placebo got me there,
I’m okay with that. –Absolutely! The placebo
is gonna help get you there. You’ve got to have some belief
to give them something to go on. So, cool, love it. All right, well I am going…–I’m gonna post a couple more questions over here real quick, I’m gonna put them over there for you. –Oh, okay, good, yeah. Oh, good. Okay, it says “it took some time but I now have some healthy
entrepreneurs who visit my clinic every two months. Without the AcuGraph, they only
came in when something went wrong.” Beautiful. Virginia says, “I’d like to use it
conducting a clinical trial in children with post-operative ileus. I’m trying to get financing.” Oh, outstanding, that would be wonderful. There
have been some very interesting trials conducted over the years with AcuGraph,
and we always love to see that kind of work done. I spoke with someone
literally yesterday, who has written up an article about a case study and wants
to send it to us, and so we’re looking forward to putting that out. Of course,
when we get things like that, we love to share them and put them on the blog. Guy says, “several of our clients did not believe before treatments but have
become believers after treatments.” Well, here you go, isn’t it interesting that
word belief keeps coming up? Kimberly you said people said, oh well I don’t believe in that. It’s like, to me that’s like saying I don’t
believe in electricity. I don’t care if you believe in electricity, if you flip the switch
the light is gonna come on, it works you don’t have to believe. However, you’re
not gonna go flip a switch if you don’t think it’s gonna work, right? So, using the belief in acupuncture gets people to flip that switch, gets
people to come in and then it just reinforces the results are getting. Okay folks, well, thank you
everybody. I can’t believe we got it done in an hour. I hope
you got some great information out of this today, we will look forward to seeing
you next time. Until then, have a Happy Thanksgiving! Have a wonderful
weekend, and we will see you at our next live webinar.
Bye everybody!

1 thought on “Acupuncture Proof, Placebo and Powerful Marketing”

  1. Compelling arguments — thank you for sharing and especially for continually measuring across so many practitioners for its statistical relevance.

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