The mystery of the orgasm [Pharyngula]

Perhaps we need to think more about human psychology. There’s an interesting phenomenon that goes on all the time when people read about evolution: they shoehorn the observations into some functional purpose. There’s just something so satisfying to our minds to be able to say “that thing exists for this particular reason”, and we find it frustrating to say, “there is no reason for it, it’s just chance and circumstance”. It shouldn’t be so, but our minds just try to fit everything into that particular mold.

Now watch: some people — maybe even you — are going to now try and develop an adaptive scenario for why having brains that work that way is a good thing. We try to build a teleological framework around everything, and so it must have a purpose that is being fulfilled, and we rarely stop to think about whether it may be actually limiting us. Maybe it’s not good. Maybe there are other ways that brains can work, and this particular mode of thinking is just a clumsy kludge that resulted from the gradual agglomeration of stuff, mostly unselected, that built up the substrate for human cognition.

A case in point: the female orgasm. There’s a new paper out on the subject, and there are lots of articles being written on it, and they generally start out by pointing out that there’s something puzzling about the phenomenon: shouldn’t it have, you know, a reason for existence? It can’t just be, it has to do something useful for women, or reproduction, or pair bonding, or any of dozens of hypotheses that have been proposed.

So NPR finds closure in an explanation.

A pair of scientists have a new hypothesis about why the female orgasm exists: it might have something to do with releasing an egg to be fertilized.

Nope. That’s not what the paper says. It says it might be a relic of a historical endocrine function, not that it plays any role in women today.

Carl Zimmer sets up a mystery.

An eye is for seeing, a nose is for smelling. Many aspects of the human body have obvious purposes.

But some defy easy explanation. For biologists, few phenomena are as mysterious as the female orgasm.

I would challenge his analogy: what’s so obvious about a nose? Nostrils and an olfactory epithelium, sure — that does have a clear functional role, and we can see signs of selection in the signal transduction apparatus, but why do we have this bony projection with a knob of cartilage on the end? We think we’d look weird without it (like Voldemort), but there’s a wide range of shapes within our species, and related species — chimps and gorillas, for instance — don’t have much in the way of a nose. It doesn’t affect their ability to smell.

(Note: both of those links take you to good summaries. I’m just weirdly conscious of how much we all take adaptive thinking for granted.)

This is the point where I tell you all to go read The Case of the Female Orgasm: Bias in the Science of Evolution by Elisabeth Lloyd, in which she takes apart a collection of adaptive scenarios that simply do not hold up. We ought to face facts: orgasm in women has nothing at all to do with reproduction. It doesn’t facilitate transport of semen, it doesn’t make them want to lie down horizontally, it doesn’t compel them to pair bond with men (since masturbation is a more effective path to orgasm than intercourse, why aren’t we arguing that the clitoris is the devil’s tool to drive women away from men? Oh, some do.)

Fortunately, this new paper by Pavlicev and Wagner, The Evolutionary Origin of Female Orgasm, doesn’t succumb to the fallacy of the spurious adaptive explanation. Instead, it’s following a much more useful evolutionary tradition: everything is the way it is because of how it got that way. Every living thing has a line of ancestry, and we inherit with modification the traits of our lineage, and the necessary way to study these traits, since our ancestors aren’t generally available for examination, is to take a comparative approach. So they do the evolutionary biology thing and ask what functions female orgasm have in related species, and try to infer an ancestral role in pre-humans.

Here, we note that most hypotheses are seeking an explanation for the presence of female orgasm within the human or primate lineage, whether due to direct or correlated effects of selection. Yet we will argue below that female orgasm, as male orgasm, predate the primate lineage, and the orgasm of human females likely evolved from an ancestral and adaptive trait, which might not have all the characteristics of human orgasm and may also have had a different function. We propose that explanations focusing on primate mating system and behavior thus address the primate-specific (or sometimes human-specific) modifications of a previously existent trait rather than its origin (Amundson, 2008). Our focus here will be the question what that ancestral trait may have been. As the lineage-specific modifications or secondary cooption (“exaptation,” in terms of Gould and Vrba, 1982) can take extreme forms under different, internal, or external selective forces, we therefore do not expect to find in animals a female orgasm as we know it in human, but are rather seeking its homologue in other species.

They also place it in the context of more general theories about the basis of the female orgasm.

The field addressing the role of female orgasm is by no means short of hypotheses. The evolutionary hypotheses align in two groups: one group argues that it is not quite true that female orgasm has no effect on reproductive success (e.g., enabling female choice, bonding, etc.), and the other group argues that it may indeed have no reproductive value in the females, but rather its existence is explained as a correlated effect of another selected trait, or a different developmental stage. For example, one well appreciated among the later hypotheses describes female orgasm as a fortunate consequence of the shared developmental basis of clitoris and penis, and therefore a consequence of reproductive necessity of the male orgasm (by-product hypothesis, Symons, 1979). A critical review of the existing hypotheses has been published in Lloyd (2005) and will not be attempted here.

So the two general hypotheses are that it has an as-yet-undetermined reproductive function (this is so far unsupported by the evidence), or that it is a byproduct of other properties. Pavlicev and Wagner are, I think, adding some other nuances to the story, but their explanation is actually orthogonal to those two explanations.

Pavlicev and Wagner point out that induced ovulation is common in mammals, and is probably a basal trait of the clade, although it has been repeatedly gained and lost. It’s an energy saving measure; why should the female spontaneously ovulate all the time, in the absence of an opportunity to become pregnant? We take it for granted — nuns continue to menstruate, after all — but many mammals do not ovulate unless they receive an endocrine signal that announces to their ovaries that hey, you’re actually mating, this might be a good time to drop an egg for fertilization. In these species, the clitoris seems to be the trigger — stimulating it induces an endocrine surge that induces ovulation. So the idea is that humans have female orgasms because our distant mammalian ancestors had all this complex hormonal machinery coupling ovulation and coitus, and we’ve lost the necessity, but the apparatus is still there. We’ve dismantled the factory, but the remnants still make a fine playground.

Another interesting pattern they see is that when ovulation is uncoupled from clitoral stimulation, there is a tendency for the clitoris to waner farther from the vaginal opening. Induced ovulators tend to have the clitoris positioned right near or even within the vaginal opening, but in animals like humans, it’s quite far away and is poorly stimulated by vaginal thrusting. This may be another of those byproducts: the opening of the urethra happens to be between the vagina and the clitoris, so the increasing separation of the clitoris and vagina may be a consequence of increasing the separation of the urethra and vagina.

I do have some slight reservations about the paper, though. One is that the explanation is insufficient. Here’s their diagram of the phylogenetic distribution of induced ovulation.

Phylogenetic distribution of (A) modes of ovulation, (B) the presence of the urogenital sinus (UGS; in basal species: cloaca), and (C) the position of clitoris relative to the vaginal orifice (in, border, out). Note the phylogenetic correlation between spontaneous ovulation with the reduction of the urogenital sinus, and the external position of the clitoris. This correlation is suggestive of an ancestral role of clitoral stimulation for the initiation of pregnancy in induced ovulators and the loss of this function in spontaneous ovulators.

Note that our lineage seems to have lost this property at the separation of rodents and primates! One estimate is that this divergence occurred about 96 million years ago, so our ancestors had to have lost the requirement to link clitoral stimulation to reproduction deep in the Cretaceous, yet still maintained the association between clitoral stimulation and orgasm to the modern day.

That retention is still best explained by the byproduct hypothesis — the pleasure circuitry is maintained by ongoing selection for its operation in males, and there’s no purpose to untangling it and removing it from females, and in fact, selecting for anorgasmia in females might have unfortunate reproductive side effects in males.

I’d also suggest that it doesn’t answer another question: why does sex feel good? We have other urges that our physiology doesn’t address by inducing super-charged sensations — I mean, why don’t we have wild orgasms every time we urinate? Why doesn’t my thyroid send ripples of joy through my body when I balance my salt intake? If you’ve ever watched cats mating, you also know that sex for them is more a matter of compulsion than an opportunity to revel in pleasurable sensations by choice. Do salmon enjoy thrashing themselves to death? I might also argue that to some human males sex isn’t a matter so much of feeling good as it is conquest, expressing dominance, and flaunting their social potency to their peers, so there are clearly alternative mechanisms to make sure males mate with females.

I might suggest that the mystery isn’t the female orgasm, but the orgasm, period. But it’s only a mystery if you insist on demanding a direct adaptive explanation for its existence.

from ScienceBlogs http://ift.tt/2arDD66

Perhaps we need to think more about human psychology. There’s an interesting phenomenon that goes on all the time when people read about evolution: they shoehorn the observations into some functional purpose. There’s just something so satisfying to our minds to be able to say “that thing exists for this particular reason”, and we find it frustrating to say, “there is no reason for it, it’s just chance and circumstance”. It shouldn’t be so, but our minds just try to fit everything into that particular mold.

Now watch: some people — maybe even you — are going to now try and develop an adaptive scenario for why having brains that work that way is a good thing. We try to build a teleological framework around everything, and so it must have a purpose that is being fulfilled, and we rarely stop to think about whether it may be actually limiting us. Maybe it’s not good. Maybe there are other ways that brains can work, and this particular mode of thinking is just a clumsy kludge that resulted from the gradual agglomeration of stuff, mostly unselected, that built up the substrate for human cognition.

A case in point: the female orgasm. There’s a new paper out on the subject, and there are lots of articles being written on it, and they generally start out by pointing out that there’s something puzzling about the phenomenon: shouldn’t it have, you know, a reason for existence? It can’t just be, it has to do something useful for women, or reproduction, or pair bonding, or any of dozens of hypotheses that have been proposed.

So NPR finds closure in an explanation.

A pair of scientists have a new hypothesis about why the female orgasm exists: it might have something to do with releasing an egg to be fertilized.

Nope. That’s not what the paper says. It says it might be a relic of a historical endocrine function, not that it plays any role in women today.

Carl Zimmer sets up a mystery.

An eye is for seeing, a nose is for smelling. Many aspects of the human body have obvious purposes.

But some defy easy explanation. For biologists, few phenomena are as mysterious as the female orgasm.

I would challenge his analogy: what’s so obvious about a nose? Nostrils and an olfactory epithelium, sure — that does have a clear functional role, and we can see signs of selection in the signal transduction apparatus, but why do we have this bony projection with a knob of cartilage on the end? We think we’d look weird without it (like Voldemort), but there’s a wide range of shapes within our species, and related species — chimps and gorillas, for instance — don’t have much in the way of a nose. It doesn’t affect their ability to smell.

(Note: both of those links take you to good summaries. I’m just weirdly conscious of how much we all take adaptive thinking for granted.)

This is the point where I tell you all to go read The Case of the Female Orgasm: Bias in the Science of Evolution by Elisabeth Lloyd, in which she takes apart a collection of adaptive scenarios that simply do not hold up. We ought to face facts: orgasm in women has nothing at all to do with reproduction. It doesn’t facilitate transport of semen, it doesn’t make them want to lie down horizontally, it doesn’t compel them to pair bond with men (since masturbation is a more effective path to orgasm than intercourse, why aren’t we arguing that the clitoris is the devil’s tool to drive women away from men? Oh, some do.)

Fortunately, this new paper by Pavlicev and Wagner, The Evolutionary Origin of Female Orgasm, doesn’t succumb to the fallacy of the spurious adaptive explanation. Instead, it’s following a much more useful evolutionary tradition: everything is the way it is because of how it got that way. Every living thing has a line of ancestry, and we inherit with modification the traits of our lineage, and the necessary way to study these traits, since our ancestors aren’t generally available for examination, is to take a comparative approach. So they do the evolutionary biology thing and ask what functions female orgasm have in related species, and try to infer an ancestral role in pre-humans.

Here, we note that most hypotheses are seeking an explanation for the presence of female orgasm within the human or primate lineage, whether due to direct or correlated effects of selection. Yet we will argue below that female orgasm, as male orgasm, predate the primate lineage, and the orgasm of human females likely evolved from an ancestral and adaptive trait, which might not have all the characteristics of human orgasm and may also have had a different function. We propose that explanations focusing on primate mating system and behavior thus address the primate-specific (or sometimes human-specific) modifications of a previously existent trait rather than its origin (Amundson, 2008). Our focus here will be the question what that ancestral trait may have been. As the lineage-specific modifications or secondary cooption (“exaptation,” in terms of Gould and Vrba, 1982) can take extreme forms under different, internal, or external selective forces, we therefore do not expect to find in animals a female orgasm as we know it in human, but are rather seeking its homologue in other species.

They also place it in the context of more general theories about the basis of the female orgasm.

The field addressing the role of female orgasm is by no means short of hypotheses. The evolutionary hypotheses align in two groups: one group argues that it is not quite true that female orgasm has no effect on reproductive success (e.g., enabling female choice, bonding, etc.), and the other group argues that it may indeed have no reproductive value in the females, but rather its existence is explained as a correlated effect of another selected trait, or a different developmental stage. For example, one well appreciated among the later hypotheses describes female orgasm as a fortunate consequence of the shared developmental basis of clitoris and penis, and therefore a consequence of reproductive necessity of the male orgasm (by-product hypothesis, Symons, 1979). A critical review of the existing hypotheses has been published in Lloyd (2005) and will not be attempted here.

So the two general hypotheses are that it has an as-yet-undetermined reproductive function (this is so far unsupported by the evidence), or that it is a byproduct of other properties. Pavlicev and Wagner are, I think, adding some other nuances to the story, but their explanation is actually orthogonal to those two explanations.

Pavlicev and Wagner point out that induced ovulation is common in mammals, and is probably a basal trait of the clade, although it has been repeatedly gained and lost. It’s an energy saving measure; why should the female spontaneously ovulate all the time, in the absence of an opportunity to become pregnant? We take it for granted — nuns continue to menstruate, after all — but many mammals do not ovulate unless they receive an endocrine signal that announces to their ovaries that hey, you’re actually mating, this might be a good time to drop an egg for fertilization. In these species, the clitoris seems to be the trigger — stimulating it induces an endocrine surge that induces ovulation. So the idea is that humans have female orgasms because our distant mammalian ancestors had all this complex hormonal machinery coupling ovulation and coitus, and we’ve lost the necessity, but the apparatus is still there. We’ve dismantled the factory, but the remnants still make a fine playground.

Another interesting pattern they see is that when ovulation is uncoupled from clitoral stimulation, there is a tendency for the clitoris to waner farther from the vaginal opening. Induced ovulators tend to have the clitoris positioned right near or even within the vaginal opening, but in animals like humans, it’s quite far away and is poorly stimulated by vaginal thrusting. This may be another of those byproducts: the opening of the urethra happens to be between the vagina and the clitoris, so the increasing separation of the clitoris and vagina may be a consequence of increasing the separation of the urethra and vagina.

I do have some slight reservations about the paper, though. One is that the explanation is insufficient. Here’s their diagram of the phylogenetic distribution of induced ovulation.

Phylogenetic distribution of (A) modes of ovulation, (B) the presence of the urogenital sinus (UGS; in basal species: cloaca), and (C) the position of clitoris relative to the vaginal orifice (in, border, out). Note the phylogenetic correlation between spontaneous ovulation with the reduction of the urogenital sinus, and the external position of the clitoris. This correlation is suggestive of an ancestral role of clitoral stimulation for the initiation of pregnancy in induced ovulators and the loss of this function in spontaneous ovulators.

Note that our lineage seems to have lost this property at the separation of rodents and primates! One estimate is that this divergence occurred about 96 million years ago, so our ancestors had to have lost the requirement to link clitoral stimulation to reproduction deep in the Cretaceous, yet still maintained the association between clitoral stimulation and orgasm to the modern day.

That retention is still best explained by the byproduct hypothesis — the pleasure circuitry is maintained by ongoing selection for its operation in males, and there’s no purpose to untangling it and removing it from females, and in fact, selecting for anorgasmia in females might have unfortunate reproductive side effects in males.

I’d also suggest that it doesn’t answer another question: why does sex feel good? We have other urges that our physiology doesn’t address by inducing super-charged sensations — I mean, why don’t we have wild orgasms every time we urinate? Why doesn’t my thyroid send ripples of joy through my body when I balance my salt intake? If you’ve ever watched cats mating, you also know that sex for them is more a matter of compulsion than an opportunity to revel in pleasurable sensations by choice. Do salmon enjoy thrashing themselves to death? I might also argue that to some human males sex isn’t a matter so much of feeling good as it is conquest, expressing dominance, and flaunting their social potency to their peers, so there are clearly alternative mechanisms to make sure males mate with females.

I might suggest that the mystery isn’t the female orgasm, but the orgasm, period. But it’s only a mystery if you insist on demanding a direct adaptive explanation for its existence.

from ScienceBlogs http://ift.tt/2arDD66

Reaction selectivity in the synthesis of paeoveitol

Xu, Liu, Xu, Gao, and Zhao report a very efficient synthesis of paeoveitol 1 by the [4+2]-cycloaddition of paeveitol D 2 with the o-quinone methide 3.¹ What is interesting here is the selectivity of this reaction. In principle the cyloadditon can give four products (2 different regioisomeric additions along with endo/exo selectivity) and it could also proceed via a Michael addition.

They performed PCM(CH₂Cl₂)/M06-2x/6-311+G(d,p) computations on the reaction of 2 with 3 and located two different transition states for the Michael addition and the four cycloaddition transition states. The lowest energy Michael and cycloaddition transition states are shown in Figure 1. The barrier for the cycloaddition is 17.6 kcal mol^-1, 2.5 kcal mol^-1 below that of the Michael addition. The barriers for the other cycloaddition paths are at more than 10 kcal mol^-1 above the one shown. This cycloaddition TS is favored by a strong intermolecular hydrogen bond and by π-π-stacking. In agreement with experiment, it is the transition state that leads to the observed product.

Michael TS (20.1)

[4+2] TS (17.6)

Figure 1. Optimized geometries of the lowest energy TSs for the Michael and [4+2]cycloaddtion routes. Barrier heights (kcal mol^-1) are listed in parenthesis.

References

(1) Xu, L.; Liu, F.; Xu, L.-W.; Gao, Z.; Zhao, Y.-M. "A Total Synthesis of Paeoveitol," Org. Lett. 2016, ASAP, DOI: 10.1021/acs.orglett.6b01736.

paeoveitol 1: InChI=1S/C21H24O3/c1-5-21-10-14-6-11(2)17(22)8-15(14)13(4)20(21)24-19-7-12(3)18(23)9-16(19)21/h6-9,13,20,22-23H,5,10H2,1-4H3/t13-,20-,21-/m1/s1
InChIKey=LCLFTLPUJXVULB-OBVPDXSSSA-N

paeveitol D 2: InChI=1S/C9H10O2/c1-3-7-5-8(10)6(2)4-9(7)11/h3-5,10H,1-2H3/b7-3+
InChIKey=KWDDAFOCZGDLEG-XVNBXDOJSA-N

3: InChI=1S/C9H10O2/c1-3-7-5-8(10)6(2)4-9(7)11/h3-5,10H,1-2H3/b7-3+
InChIKey=KWDDAFOCZGDLEG-XVNBXDOJSA-N

from Computational Organic Chemistry http://ift.tt/2aK94Xx

Xu, Liu, Xu, Gao, and Zhao report a very efficient synthesis of paeoveitol 1 by the [4+2]-cycloaddition of paeveitol D 2 with the o-quinone methide 3.¹ What is interesting here is the selectivity of this reaction. In principle the cyloadditon can give four products (2 different regioisomeric additions along with endo/exo selectivity) and it could also proceed via a Michael addition.

They performed PCM(CH₂Cl₂)/M06-2x/6-311+G(d,p) computations on the reaction of 2 with 3 and located two different transition states for the Michael addition and the four cycloaddition transition states. The lowest energy Michael and cycloaddition transition states are shown in Figure 1. The barrier for the cycloaddition is 17.6 kcal mol^-1, 2.5 kcal mol^-1 below that of the Michael addition. The barriers for the other cycloaddition paths are at more than 10 kcal mol^-1 above the one shown. This cycloaddition TS is favored by a strong intermolecular hydrogen bond and by π-π-stacking. In agreement with experiment, it is the transition state that leads to the observed product.

Michael TS (20.1)

[4+2] TS (17.6)

Figure 1. Optimized geometries of the lowest energy TSs for the Michael and [4+2]cycloaddtion routes. Barrier heights (kcal mol^-1) are listed in parenthesis.

References

(1) Xu, L.; Liu, F.; Xu, L.-W.; Gao, Z.; Zhao, Y.-M. "A Total Synthesis of Paeoveitol," Org. Lett. 2016, ASAP, DOI: 10.1021/acs.orglett.6b01736.

paeoveitol 1: InChI=1S/C21H24O3/c1-5-21-10-14-6-11(2)17(22)8-15(14)13(4)20(21)24-19-7-12(3)18(23)9-16(19)21/h6-9,13,20,22-23H,5,10H2,1-4H3/t13-,20-,21-/m1/s1
InChIKey=LCLFTLPUJXVULB-OBVPDXSSSA-N

paeveitol D 2: InChI=1S/C9H10O2/c1-3-7-5-8(10)6(2)4-9(7)11/h3-5,10H,1-2H3/b7-3+
InChIKey=KWDDAFOCZGDLEG-XVNBXDOJSA-N

3: InChI=1S/C9H10O2/c1-3-7-5-8(10)6(2)4-9(7)11/h3-5,10H,1-2H3/b7-3+
InChIKey=KWDDAFOCZGDLEG-XVNBXDOJSA-N

from Computational Organic Chemistry http://ift.tt/2aK94Xx

New Supercomputing Partnership Creates Opportunities for Scientific Discovery

By ARL Public Affairs

The University of Maryland and the U.S. Army Research Laboratory, the central laboratory that provides world-class basic research for the Army, today announced a strategic partnership to provide high-performance computing resources for use in higher education and research communities.

As a result of this synergistic partnership, students, professors, engineers, and researchers will have unprecedented access to technologies that enable scientific discovery and innovation.

The partnership was formed under ARL’s “Open Campus” initiative, and in collaboration with DOD HPC Modernization Office. Mid-Atlantic Crossroads, or MAX, a University of Maryland center that operates a multi-state advanced cyberinfrastructure platform, will connect ARL’s high-performance computer “Harold” to this ecosystem on its 100-Gbps optical network. Collaborators from the UMD, MAX, and ARL communities will be able to build research networks, explore complex problems, engage in competitive research opportunities, and encounter realistic research applications.

“The UMD/MAX-ARL partnership provides a unique opportunity for both organizations to create a national model of collaboration in the HPC field,” said Tripti Sinha, MAX Executive Director and UMD Assistant Vice President and Chief Technology Officer. “Collaborative partnerships are key to maximizing our technological potential and ensuring our nation’s strength and competitiveness in the critical fields of science and research. UMD and MAX are very excited to work with ARL on this endeavor.” 

In addition to increasing accessibility and enhancing HPC resources for researchers, the collaboration between UMD/MAX and ARL will also support innovation activities conducted by private and startup companies that connect through MAX’s infrastructure.

“Our goal is to take the cutting-edge computational power that we use for defense research, development, test, and evaluation and put that in a place that will benefit the wider scientific community,” said Dr. Raju Namburu, Chief, Computational Sciences Division, Computational and Information Sciences Directorate, U.S. Army Research Laboratory.

UMD, MAX, and ARL’s combined effort not only benefits the mid-Atlantic region, but also aligns with the federal government’s strategic initiative to maximize the benefits of supercomputing for economic competitiveness, scientific discovery, and national security.

An executive order announced in July 2015 established the National Strategic Computing Initiative to support the U.S. in its efforts to remain a leader in the development and deployment of HPC systems.

“The university is in full support of the federal government’s leadership on this critical HPC initiative,” said Eric Denna, UMD Vice President and Chief Information Officer. “The creation of the UMD/MAX-ARL partnership is just one step in the promotion of HPC innovation, and UMD will continue to actively participate by contributing technical expertise and sharing knowledge with our key collaborators.”

The UMD/MAX-ARL partnership also lays the foundation for the organizations to expand their reach and make additional HPC resources accessible to the communities they serve.

Harold will become available once the machine is scrubbed, declassified, and brought into ARL’s demilitarized zone, or perimeter network. Under ARL and UMD’s collaborative research development agreement, the HPC resource will be allocated to MAX’s Internet Protocol address space and will be accessible to the collective communities of UMD, MAX, and ARL’s Open Campus.

As a result, researchers will have supercomputing-caliber computational capability and leading-edge advanced networking research at their fingertips that is designed for application development and networking experiments.

“This joint research venture with UMD/MAX will leverage ARL’s high-performance resources and the Army’s groundbreaking research programs in emerging scientific computing architectures, such as non Von Neumann computing architectures, distributed ad-hoc computing, and programmable networks,” Namburu said. “The result is a unique opportunity for synergistic collaboration between two prominent organizations on the forefront of research and innovation.”

The ultimate goal is to share HPC resources for the good of the community and ensure that groundbreaking collaborative projects have the necessary tools.

“An HPC resource like Harold will significantly enhance the capabilities of the University of Maryland’s faculty and student researchers,” said Patrick O’Shea, UMD Vice President and Chief Research Officer. “The partnership between UMD/MAX and ARL opens up connections for our community and enables research opportunities. We are eager to see the expansion of our creative ecosystem.”

Follow U.S. Department of Defense on Twitter!

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from Armed with Science http://ift.tt/2arLyKe

By ARL Public Affairs

The University of Maryland and the U.S. Army Research Laboratory, the central laboratory that provides world-class basic research for the Army, today announced a strategic partnership to provide high-performance computing resources for use in higher education and research communities.

As a result of this synergistic partnership, students, professors, engineers, and researchers will have unprecedented access to technologies that enable scientific discovery and innovation.

The partnership was formed under ARL’s “Open Campus” initiative, and in collaboration with DOD HPC Modernization Office. Mid-Atlantic Crossroads, or MAX, a University of Maryland center that operates a multi-state advanced cyberinfrastructure platform, will connect ARL’s high-performance computer “Harold” to this ecosystem on its 100-Gbps optical network. Collaborators from the UMD, MAX, and ARL communities will be able to build research networks, explore complex problems, engage in competitive research opportunities, and encounter realistic research applications.

“The UMD/MAX-ARL partnership provides a unique opportunity for both organizations to create a national model of collaboration in the HPC field,” said Tripti Sinha, MAX Executive Director and UMD Assistant Vice President and Chief Technology Officer. “Collaborative partnerships are key to maximizing our technological potential and ensuring our nation’s strength and competitiveness in the critical fields of science and research. UMD and MAX are very excited to work with ARL on this endeavor.” 

In addition to increasing accessibility and enhancing HPC resources for researchers, the collaboration between UMD/MAX and ARL will also support innovation activities conducted by private and startup companies that connect through MAX’s infrastructure.

“Our goal is to take the cutting-edge computational power that we use for defense research, development, test, and evaluation and put that in a place that will benefit the wider scientific community,” said Dr. Raju Namburu, Chief, Computational Sciences Division, Computational and Information Sciences Directorate, U.S. Army Research Laboratory.

UMD, MAX, and ARL’s combined effort not only benefits the mid-Atlantic region, but also aligns with the federal government’s strategic initiative to maximize the benefits of supercomputing for economic competitiveness, scientific discovery, and national security.

An executive order announced in July 2015 established the National Strategic Computing Initiative to support the U.S. in its efforts to remain a leader in the development and deployment of HPC systems.

“The university is in full support of the federal government’s leadership on this critical HPC initiative,” said Eric Denna, UMD Vice President and Chief Information Officer. “The creation of the UMD/MAX-ARL partnership is just one step in the promotion of HPC innovation, and UMD will continue to actively participate by contributing technical expertise and sharing knowledge with our key collaborators.”

The UMD/MAX-ARL partnership also lays the foundation for the organizations to expand their reach and make additional HPC resources accessible to the communities they serve.

Harold will become available once the machine is scrubbed, declassified, and brought into ARL’s demilitarized zone, or perimeter network. Under ARL and UMD’s collaborative research development agreement, the HPC resource will be allocated to MAX’s Internet Protocol address space and will be accessible to the collective communities of UMD, MAX, and ARL’s Open Campus.

As a result, researchers will have supercomputing-caliber computational capability and leading-edge advanced networking research at their fingertips that is designed for application development and networking experiments.

“This joint research venture with UMD/MAX will leverage ARL’s high-performance resources and the Army’s groundbreaking research programs in emerging scientific computing architectures, such as non Von Neumann computing architectures, distributed ad-hoc computing, and programmable networks,” Namburu said. “The result is a unique opportunity for synergistic collaboration between two prominent organizations on the forefront of research and innovation.”

The ultimate goal is to share HPC resources for the good of the community and ensure that groundbreaking collaborative projects have the necessary tools.

“An HPC resource like Harold will significantly enhance the capabilities of the University of Maryland’s faculty and student researchers,” said Patrick O’Shea, UMD Vice President and Chief Research Officer. “The partnership between UMD/MAX and ARL opens up connections for our community and enables research opportunities. We are eager to see the expansion of our creative ecosystem.”

Follow U.S. Department of Defense on Twitter!

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Star lashes companion with mystery ray

Artist’s concept of exotic binary star system AR Scorpii. Image via M. Garlick/University of Warwick, ESA/Hubble

Both professional and amateur astronomers have been peering toward the star system AR Scorpii, or AR Sco for short, 380 light-years from Earth. Identified in the 1970s as a lone variable star, it’s now believed to be a double system with a rapidly spinning white dwarf (Earth-sized but with 200,000 times more mass), and a cool red dwarf companion (about a third the mass of our sun). These two dwarf stars are orbiting each other every 3.6 hours. Astronomers said on July 27, 2016 that the system is:

… a new type of exotic binary star.

They say high energy particles from the white dwarf are lashing the companion red dwarf star, causing the entire system to pulse dramatically every 1.97 minutes with radiation ranging from the ultraviolet to radio. They’ve never seen this sort of behavior in a white dwarf system before.

A group of amateur astronomers from Germany, Belgium and the UK began observing this system in May 2015. They noticed its unusual behavior. Follow-up observations have been led by Tom Marsh of the University of Warwick, using telescopes on the ground and in space including the Hubble Space Telescope.

ESA explained in a statement:

Highly magnetic and spinning rapidly, AR Sco’s white dwarf accelerates electrons up to almost the speed of light. As these high energy particles whip through space, they release radiation in a lighthouse-like beam which lashes across the face of the cool red dwarf star, causing the entire system to brighten and fade dramatically every 1.97 minutes. These powerful pulses include radiation at radio frequencies, which has never been detected before from a white dwarf system.

The radiation across a broad range of frequencies isn’t mysterious. It’s a sign of electrons accelerated in magnetic fields, which can be explained by AR Sco’s spinning white dwarf.

But the source of the electrons is a major mystery. Astronomers still aren’t sure whether that source was the white dwarf, or its cooler companion.

The true source of AR Scorpii’s varying luminosity was revealed thanks to the combined efforts of amateur and professional astronomers. Boris Gänsicke, co-author of the new study, commented:

We’ve known about pulsing neutron stars for nearly 50 years, and some theories predicted white dwarfs could show similar behavior. It’s very exciting that we have discovered such a system, and it has been a fantastic example of amateur astronomers and academics working together.

The zoom sequence below takes you from a wide-field view of our Milky Way galaxy in the night sky into the bright constellation of Scorpius the Scorpion. The final view is centered on the exotic binary star AR Scorpii.

Bottom line: Astronomers thought the star AR Scorpii was a lone variable star. Now they realize it’s a dwarf star bombarding its companion with relativistic electrons.

Via ESA

from EarthSky http://ift.tt/2aswy28

Artist’s concept of exotic binary star system AR Scorpii. Image via M. Garlick/University of Warwick, ESA/Hubble

Both professional and amateur astronomers have been peering toward the star system AR Scorpii, or AR Sco for short, 380 light-years from Earth. Identified in the 1970s as a lone variable star, it’s now believed to be a double system with a rapidly spinning white dwarf (Earth-sized but with 200,000 times more mass), and a cool red dwarf companion (about a third the mass of our sun). These two dwarf stars are orbiting each other every 3.6 hours. Astronomers said on July 27, 2016 that the system is:

… a new type of exotic binary star.

They say high energy particles from the white dwarf are lashing the companion red dwarf star, causing the entire system to pulse dramatically every 1.97 minutes with radiation ranging from the ultraviolet to radio. They’ve never seen this sort of behavior in a white dwarf system before.

A group of amateur astronomers from Germany, Belgium and the UK began observing this system in May 2015. They noticed its unusual behavior. Follow-up observations have been led by Tom Marsh of the University of Warwick, using telescopes on the ground and in space including the Hubble Space Telescope.

ESA explained in a statement:

Highly magnetic and spinning rapidly, AR Sco’s white dwarf accelerates electrons up to almost the speed of light. As these high energy particles whip through space, they release radiation in a lighthouse-like beam which lashes across the face of the cool red dwarf star, causing the entire system to brighten and fade dramatically every 1.97 minutes. These powerful pulses include radiation at radio frequencies, which has never been detected before from a white dwarf system.

The radiation across a broad range of frequencies isn’t mysterious. It’s a sign of electrons accelerated in magnetic fields, which can be explained by AR Sco’s spinning white dwarf.

But the source of the electrons is a major mystery. Astronomers still aren’t sure whether that source was the white dwarf, or its cooler companion.

The true source of AR Scorpii’s varying luminosity was revealed thanks to the combined efforts of amateur and professional astronomers. Boris Gänsicke, co-author of the new study, commented:

We’ve known about pulsing neutron stars for nearly 50 years, and some theories predicted white dwarfs could show similar behavior. It’s very exciting that we have discovered such a system, and it has been a fantastic example of amateur astronomers and academics working together.

The zoom sequence below takes you from a wide-field view of our Milky Way galaxy in the night sky into the bright constellation of Scorpius the Scorpion. The final view is centered on the exotic binary star AR Scorpii.

Bottom line: Astronomers thought the star AR Scorpii was a lone variable star. Now they realize it’s a dwarf star bombarding its companion with relativistic electrons.

Via ESA

from EarthSky http://ift.tt/2aswy28

Time to see the starlit Milky Way

Tonight – August 2, 2016 – is a great time to look for the starry band of the Milky Way, the edgewise view into our own galaxy. That’s because the moon reaches its new phase on August 2. That means that, over the coming week, the waxing crescent moon will set soon after sunset and be mostly absent from the evening sky. And a moonless sky – in a rural location – provides the best views of the Milky Way at this time of year, when we are looking toward the galaxy’s center in the evening.

No matter where you are on Earth, you can look edgewise into the Milky Way this month – assuming you have a dark sky. When you look at it with the eye alone, you’ll see a hazy band across the sky.

But you’ll see the truth if you’ll peer at the Milky Way with an ordinary pair of binoculars. Binoculars cause the “haze” to appear as myriad, distant stars.

Enjoying EarthSky so far? Sign up for our free daily newsletter today!

When you look edgewise into the disk of our own Milky Way galaxy, you see it as a hazy band of stars across a dark night sky. Dark clouds of gas and dust can be seen blotting some of the light of these stars. These dark clouds are places where new stars are being born. This image of the Milky Way is from EarthSky Facebook friend Erin Cole in Australia. Thanks, Erin!

The chart at the top of this post shows a Northern Hemisphere view of the Milky Way.

The chart shows the view if you are standing facing east on an August evening – but craning your neck to look overhead. I’ve marked some bright stars on this chart that you’ll find along the path of the Milky Way if you’re looking overhead. Vega in the constellation Lyra the Harp, Deneb in the constellation Cygnus the Swan and Altair in the constellation Aquila the Eagle make up a large star pattern, or “asterism,” known as the Summer Triangle. This entire region is a marvelous place to scan with binoculars.

Read about the Summer Triangle: Vega, Deneb, Altair

You can also see the Milky Way from the Southern Hemisphere, of course, and both photos on this page show a Southern Hemisphere view. We’re inside the galaxy. It surrounds us in space. So everyone on Earth can see it.

In fact, people on the southern half of Earth’s globe have an even more magnificent view of the Milky Way than we do in the Northern Hemisphere. From the northern part of Earth, the center of the galaxy – the richest part, where most of the galaxy’s stars reside – lies toward our southern sky on August evenings. The galactic center is fairly close to our southern horizon. If you were in the Southern Hemisphere, meanwhile, you’d see the star-packed core of the Milky Way closer to overhead. You’d see more of it, and you’d see it without any interfering haze or clouds on the horizon.

Milky Way with passing train via EarthSky Facebook friend Arthur Seabra in Brazil. Click here to expand image

Bottom line: New moon comes on August 2, 2016. The following few evenings are a wonderful time to go out in the country for an edgewise view into our own galaxy, the Milky Way. In a dark sky, the Milky Way looks like a hazy pathway across the sky. Binoculars reveal the haze as countless stars!

EarthSky astronomy kits are perfect for beginners. Order today from the EarthSky store

Donate: Your support means the world to us

from EarthSky http://ift.tt/1INm2K5

Tonight – August 2, 2016 – is a great time to look for the starry band of the Milky Way, the edgewise view into our own galaxy. That’s because the moon reaches its new phase on August 2. That means that, over the coming week, the waxing crescent moon will set soon after sunset and be mostly absent from the evening sky. And a moonless sky – in a rural location – provides the best views of the Milky Way at this time of year, when we are looking toward the galaxy’s center in the evening.

No matter where you are on Earth, you can look edgewise into the Milky Way this month – assuming you have a dark sky. When you look at it with the eye alone, you’ll see a hazy band across the sky.

But you’ll see the truth if you’ll peer at the Milky Way with an ordinary pair of binoculars. Binoculars cause the “haze” to appear as myriad, distant stars.

Enjoying EarthSky so far? Sign up for our free daily newsletter today!

When you look edgewise into the disk of our own Milky Way galaxy, you see it as a hazy band of stars across a dark night sky. Dark clouds of gas and dust can be seen blotting some of the light of these stars. These dark clouds are places where new stars are being born. This image of the Milky Way is from EarthSky Facebook friend Erin Cole in Australia. Thanks, Erin!

The chart at the top of this post shows a Northern Hemisphere view of the Milky Way.

The chart shows the view if you are standing facing east on an August evening – but craning your neck to look overhead. I’ve marked some bright stars on this chart that you’ll find along the path of the Milky Way if you’re looking overhead. Vega in the constellation Lyra the Harp, Deneb in the constellation Cygnus the Swan and Altair in the constellation Aquila the Eagle make up a large star pattern, or “asterism,” known as the Summer Triangle. This entire region is a marvelous place to scan with binoculars.

Read about the Summer Triangle: Vega, Deneb, Altair

You can also see the Milky Way from the Southern Hemisphere, of course, and both photos on this page show a Southern Hemisphere view. We’re inside the galaxy. It surrounds us in space. So everyone on Earth can see it.

In fact, people on the southern half of Earth’s globe have an even more magnificent view of the Milky Way than we do in the Northern Hemisphere. From the northern part of Earth, the center of the galaxy – the richest part, where most of the galaxy’s stars reside – lies toward our southern sky on August evenings. The galactic center is fairly close to our southern horizon. If you were in the Southern Hemisphere, meanwhile, you’d see the star-packed core of the Milky Way closer to overhead. You’d see more of it, and you’d see it without any interfering haze or clouds on the horizon.

Milky Way with passing train via EarthSky Facebook friend Arthur Seabra in Brazil. Click here to expand image

Bottom line: New moon comes on August 2, 2016. The following few evenings are a wonderful time to go out in the country for an edgewise view into our own galaxy, the Milky Way. In a dark sky, the Milky Way looks like a hazy pathway across the sky. Binoculars reveal the haze as countless stars!

EarthSky astronomy kits are perfect for beginners. Order today from the EarthSky store

Donate: Your support means the world to us

from EarthSky http://ift.tt/1INm2K5

Emergency acupuncture! [Respectful Insolence]

Many are the bizarre, dubious, and downright crappy acupuncture studies that I’ve deconstructed over the years. Just type “acupuncture” into the search box of this blog, and you’ll soon see. (If that pulls up too many results, try typing “acupuncture” and “study” or “acupuncture” and “clinical trial” in the search box.) I’m not the only one, either. For instance, my good bud Mark Crislip did his usual excellent and highly sarcastic job of deconstructing the frequent claim by acupuncture apologists that acupuncture “works” by releasing endorphins. So when I first saw an even more bizarre acupuncture study than usual, I knew I’d have to take it on sooner or later. Then last week, the Friends of Science in Medicine sent me a link to their latest article, a review of acupuncture entitled “Is there any place for acupuncture in 21st century medical practice?” Not surprisingly, the FSM (Friends of Science in Medicine, not the Flying Spaghetti Monster) concludes that the answer is no. However, in stark contrast to that conclusions are studies like the one mentioned above, studies so ridiculous that, when I discuss it, you will hardly believe that anyone thought it was a good idea to utilize the money, time, and precious, precious human subjects to answer such a ridiculous question. After that discussion, I’ll come back to the FSM’s statement and discuss the evidence base (or rather, lack thereof) for acupuncture for pretty much anything.

Emergency acupuncture!

As Mark noted, one of the most commonly invoked “explanations” (other than that it “releases adenosine” such that acupuncture apologists have tried to rebrand regional anesthesia as acupuncture based on this concept) is that acupuncture somehow stimulates the release of endorphins, natural, endogenous substances that suppress the sensation of pain. Based on dubious science, acupuncture apologists are frequently seen touting its benefits and explaining them to credulous media outlets such as Consumer Reports. Indeed, it’s amazing how far acupuncture apologists will go to justify their beliefs, frequently mislabeling TENS as acupuncture. Since endorphins are basically neurotransmitters (substances that transmit a chemical message from neuron to neuron or neuron to muscle) that stimulate the same receptors as morphine, namely opioid receptors, they function as a natural system to decrease the sensation of pain, among other functions. There are basically four types of endorphins: alpha (α), beta (β), gamma (γ) and sigma (σ), all of them peptides and distinguished by having different numbers and types of amino acids making up their structure. To put it simply, opioid pain relievers like morphine or Fentanyl mimic natural endorphins. There’s a lot of woo out there whose advocates invoke endorphins, basically any “complementary and alternative medicine” (CAM) that claims to reduce pain or make one feel better.

Enter emergency acupuncture. No, I’m not kidding you. Instead of battlefield acupuncture, which is helping to pave the way for acupuncture to infiltrate the VA Medical Center system, here we have a clinical study examining the use of acupuncture in the emergency room, published in The American Journal of Emergency Medicine, entitled “Acupuncture versus intravenous morphine in the management of acute pain in the emergency department.” No, I kid you not. Click on the link if you don’t believe me. This is a clinical trial randomizing people with acute pain to acupuncture versus intravenous morphine. Its ClinicalTrials.gov identifier is NCT02460913.

Let’s take a look at this study.

It is a phase 2 clinical trial that randomizes patients in the emergency room with acute pain to either titration of intravenous morphine or acupuncture. As you can probably imagine, it is completely unblinded. There is no sham, nor is there even an attempt at blinding. Given that, I bet you can guess the result before I even describe the study in more detail, because the results of such a study are very predictable. Let’s move on, anyway.

First, how do the investigators, who are based at two different hospitals in Tunisia affiliated with the University of Monastir, justify their study? First, they invoke a systematic review of acupuncture use in the emergency department, which, amazingly, found 102 studies. Not amazingly, only two RCTs and two uncontrolled observational studies were deemed eligible. Also not surprisingly, in line with the methodolatry that characterizes evidence-based medicine (EBM), the authors concluded that “current evidence is insufficient to make any recommendations concerning the use of acupuncture in the ED” and recommended that the “effectiveness and safety as well as the feasibility of acupuncture should be tested in future RCTs.” Of course, the science-based medicine (SBM) retort to this conclusion is that, given the extreme lack of prior plausibility of acupuncture, coupled with such equivocal clinical evidence, the most parsimonious explanation is that acupuncture doesn’t work.

Not to these investigators:

The World Health Organization (WHO) has recognized acupuncture as a safe and effective therapy for a myriad of conditions causing pain and discomfort [4]. However, the introduction of acupuncture in the treatment of pain in the ED is rare. Acupuncture was shown to be as effective as morphine and it has a better safety profile which makes it a suitable method of pain control in certain circumstances such as headaches, migraines, back pain, cervical pain and osteoarthritis [5].

Again, that damned WHO report. Basically, it was a report written by acupuncturists who made statements at odds with the evidence. Actually, in this case, the authors referenced a 2002 acupuncture report that appears to be an update to the original that acknowledges the “debt” to the acupuncturists who authored the original report. In any case, the rationale for using acupuncture in the emergency room is, as you would expect, quite weak.

Now let’s take a look at the study design, specifically the two interventions. The first part that sends up a red flag to me is this:

Patients were screened for inclusion in the triage unit during the day between the hours of 8 a.m. to 7 p.m., Monday through Friday. Eligible patients were those who presented for moderate to severe acute onset pain with stable clinical conditions that did not require any resuscitation measures or specific procedures except for treatment of painful condition.

That sounds fair enough at first, but think about it a bit more. Basically, anyone in pain could be randomized, as long as they didn’t have a clinical condition that needed immediate treatment, rather only “treatment of painful condition.” Now here’s the rub. Look at the inclusion criteria:

Patients were included in the protocol if they were aged ≥18 years and met the following criteria: Acute onset pain <72 hours of the ED presentation, pain intensity ≥40 of the VAS or NRS (ranging from 0 for no pain to 100 for maximum imaginable pain), acute musculoskeletal pain with no evidence of fracture or dislocation, including ankle and knee sprains without signs of severity (ligament rupture, laxity), shoulder and elbow tendinitis, upper and lower limb mechanical pains and lower back pain with no evidence of neurological deficit, acute abdominal pain with no urgent surgical intervention including renal colic and dysmenorrhea and acute headache that meets the criteria of primary headache, as described by the international headache society [7].

As you will see later, these criteria lead to some real problems with the study, but I’ll forego discussion of that aspect until I get to the results in favor of pitching a TV show to Lifetime called “Emergency Acupuncturists!” Don’t worry, I’ll get back to this problem soon enough, but I will hint now that the mix of patients in each group was not comparable. I’ll also mention that if I came in with pain from a kidney stone, there’s no way in hell that I would let an acupuncturist near me or agree to be randomized.

The other major problem with the study design, as I discussed before, is that it is completely unblinded. Patients, doctors, acupuncturists, everyone knew which group the patient was in. This sort of design is almost guaranteed to produce a result in which the acupuncture group shows a high degree of pain relief, thanks to placebo effects. Whether that pain relief will be more, less, or the same as the standard of care to which acupuncture is being compared varies depending on the study, but I rarely go wrong predicting that an unblinded acupuncture study will show a lot of benefit for acupuncture, sometimes even the same as or greater than standard of care.

Now let’s look at the two interventions. First, the acupuncture:

After allocation to this group, patients were redirected to the ED acupuncture unit. The acupuncturist was an ED doctor with medical acupuncture qualification accredited by the National Tunisian Council of Doctors with 10 years experience in the field. Treatment protocols were determined through review of major clinical manuals and textbooks, literature review, and a panel of specialist acupuncturists from Chinese medicine backgrounds [8]. The protocols, which allow acupuncture points to be selected from a pool of pre-determined points for each condition, provide sufficient standardization to assist replication, yet are flexible enough to allow individualized treatments. These protocols also allow for additional points, such as ‘ashi points’, to be used at the discretion of the acupuncturist. The location of the points, angle of insertion and depth of insertion were sourced from a popular text “A Manual of Acupuncture” [9] and described in the annexe table (annexe1). The average time to place needles is five minutes.

So basically acupuncturists could choose any points they wished. Of course, as I’ve pointed out before, acupuncture “works” (i.e., produces placebo effects) whether you put the needles into the “right” points or not. It doesn’t even matter if you actually insert the needles, as long as you touch the skin (even with toothpicks instead of needles)! Be that as it may, there was not even an attempt to include a sham acupuncture group.

The morphine group involved titrating morphine, starting with a dose of 0.1 mg/kg and repeating the morphine at 0.05 mg/kg every five minutes until the desired decrease in pain was achieved, with a maximum total dose being 15 mg. This is a fairly standard ER protocol for treating acute pain, although other evidence suggests that a titration scheme using a protocol with an initial dose of 2 mg (body weight < 60 kg) or 3 mg (body weight > 60 kg) with subsequent administration of 3 mg of morphine every 5 minutes until desirable or adverse effects occurred is more effective. Be that as it may, we are basically seeing a test of acupuncture versus one widely utilized protocol for dosing morphine for acute pain. Also, patients were allowed to receive other treatments suitable to their conditions if judged necessary, such as ice application, compression, elevation and rest. It wasn’t clear to me if this was also the case with the acupuncture arm.

So what were the results? Here you go:

Success rate was significantly different between the two groups (92% in the Acupuncture group vs. 78% in the Morphine group P < .01). Resolution time was 16 ± 8 minutes in the acupuncture group vs. 28 ± 14 minutes in the morphine group. The difference was statistically significant (P < .01). The mean absolute difference in pain score between the two groups was 7.7. This difference is not clinically significant since the minimal clinically significant absolute difference reported by Todd et al. is 13. In Morphine group the mean total dose of Morphine administered was 0.17 ± 0.08 mg/Kg (Table2).

I’ll give the investigators credit for mentioning that a statistically significant difference does not necessarily mean a clinically significant difference in pain scores. I only wish Andrew Vickers would learn this lesson instead of attacking those who criticize his work. One also notes that a titration scheme like the one above to reduce acute pain using morphine will likely take at least 20 minutes, given that it consists of administering subtherapeutic doses of morphine, assessing reduction in pain after five minutes, and then giving an even smaller dose, rinse, lather, repeat. The reason for this, of course, is that morphine can depress respiration and decreased blood pressure, which is why clinicians need to be cautious, but such an approach inherently takes longer.

Excuses and incomparable (uncomparable?) groups!

Now, I’ll revisit what I alluded to earlier about an uneven distribution of conditions. It’s hard not to note in Table 1 that there were significantly more abdominal pain patients in the morphine group (79) than the acupuncture group (60) and that there were significantly fewer low back pain patients (27 in the morphine group vs. 44 in the acupuncture group). Given that in general we try to avoid opioids for low back pain and that low back pain often resolves with relaxation and rest, one has to wonder if these skewed the results. Similarly, the most common condition causing abdominal pain that doesn’t require immediate surgery for which it is safe to administer opioid analgesics is likely to be kidney stones, which are extremely painful and not likely to pass quickly. Given that patients with abdominal pain were the single largest group in this trial, making up close to half the total patients, one wonders why the authors didn’t break out the pain scores for this group, given that there was such an imbalance between the groups. It also concerns me that this ER is administering morphine for so many people with abdominal pain. While that is appropriate for kidney stones, it is seldom, if ever, appropriate for dysmenorrhea (painful menses).

Also, there is a big problem with the reporting of this clinical trial, so much so that I’m surprised this journal published it. There is no CONSORT flow diagram to show allocation of subjects, dropout rates, and analysis. Indeed, seeing a clinical trial in which there are exactly 150 subjects in each arm always makes my skeptical antennae start twitching. No one dropped out of the study? No one was randomized but decided not to go through with the trial? I suppose it’s possible for a short term intervention in the ER, but consider this: Accrual was exactly perfect for each group. This almost never happens in a clinical trial.

Finally, the authors try to excuse their lack of blinding:

First, the main flow of this trial is the lack of blinding. In fact, in these settings sham acupuncture has been proposed to provide a comparable experience to the study subjects and to minimize the effects of nonblinding. However, in our study sham acupuncture use would be impossible given the workload of a single acupuncturist.

I’m sorry, but there is no excuse here. If you can’t properly blind the subjects and the practitioners, then you shouldn’t even bother to do the trial, because it will be crap. Actually, the authors’ failure in blinding is double. Here’s how I would have designed the trial:

• Morphine titration + sham acupuncture
• Placebo morphine (i.e., normal saline injections) + acupuncture

This way, both patients get what they believe to be an identical experience, and you can compare acupuncture to morphine in this setting. Of course, the better design would have two more groups:

• Morphine titration + acupuncture
• Placebo morphine (i.e., normal saline injections) + sham acupuncture

If this were a study of acupuncture for a more chronic condition, I’d incorporate some sort of crossover design, but it isn’t; so I won’t.

Having these four groups would allow a complete analysis of the two interventions with far less potential for bias and placebo effects. However, in a pinch, if there aren’t resources to recruit patients for four groups like this, just including the first two groups would do nicely for a pilot project. Of course, this is an EBM standpoint. From an SBM standpoint, in which basic biology indicates a prior plausibility for acupuncture that is incredibly low, I would judge this study not worth doing, but I’d also say that if you insist on doing it anyway you should at least do it right.

Unfortunately, such is the quality of the vast majority of acupuncture studies, which brings us to the FSM statement.

Acupuncture is pointless

The FSM paper is an excellent primer on why acupuncture is pseudoscience. I encourage you to read the whole thing; I’ll only hit the highlights. First, they point out exactly what I’ve been saying about traditional Chinese medicine (TCM) for years and years now:

TCM, also present in Japan, where it is called Kampo, is, together with Indian Ayurveda and pre-Enlightenment European medicine, one of the major pre-scientific medicines. They share common roots, probably from ancient Indian philosophies, according to which the equilibrium of the healthy human body is believed to be the result of a balance of a number of elements. Diseases are thought to be due to their imbalance.

In TCM, these elements are wood, water, fire, earth and metal, a belief similar to that of ancient Indian Unani medicine, with its four humours (akhlaat) – air, earth, fire and water, and Indian Ayurveda medicine’s air, water and fire. Pre-scientific European (from Greco-Roman) medicine proposed four humours, each associated with the four natural universal elements (blood – air; phlegm – water; yellow bile – fire; black bile – earth). Although these theoretical constructs represented an initial attempt to unify knowledge about the world and ourselves, none has any scientific foundation.

This is exactly why I like to ask: Where’s the love for traditional European medicine? Teach the controversy, I say:

Many of the points (get it—”points,” acupuncture?) made by FSM are points familiar to regular readers of SBM. Acupuncture is not really ancient, given that early Chinese medical texts don’t mention it. It appears to have been more based on lancing abscesses with a larger lance and ancient bloodletting not unlike what was practiced in Europe, possibly with a bit of astrology added. Even as recently as 103 years ago, acupuncture was practiced in a barbaric fashion with very large needles, often heated, left in the body for days, sometimes resulting in death. Then, of course, there was the retconning of TCM by Chairman Mao Zedong, who didn’t really believe in TCM but didn’t have the resources to bring SBM to his entire country. So he tried to “integrate” TCM into modern medicine and dispatched hordes of “barefoot doctors” practicing TCM to fill in the breach. Then, starting in the 1960s and 1970s, stories of the wonders of acupuncture filtered to the West from China, thanks to credulous journalists.

Then there’s the veritable catalog of proposed “mechanisms” by which acupuncture “works,” including adenosine (wrong) and endorphins (again, wrong). Add to that the variability in studies, the oft-repeated observation that it doesn’t matter where you stick the needles or even if the needles pierce the skin, and it becomes clear that acupuncture is merely “theatrical placebo.” As Steve Novella likes to point out, the better designed the study, the more likely it is to show no discernable effect attributable to acupuncture greater than placebo effects. No wonder acupuncturists like unblinded studies.

Is there any justification for the use of acupuncture in modern medicine?

FSM concludes by asking the question: Is there any justification for the use of acupuncture in modern medicine? You know our answer here at SBM, but it’s worth quoting FSM:

As acupunctures loses support in Medicine, it is increasingly used as part of larger constellations of alternative treatments within private enterprises which mix together, almost randomly, any of the many pseudoscientific interventions under a generally attractive umbrella of ‘wellness’. This makes acupuncture even less reliable and hides it from public scrutiny.

Acupuncture has been studied for decades and the evidence that it can provide clinical benefits continues to be weak and inconsistent. There is no longer any justification for more studies. There is already enough evidence to confidently conclude that acupuncture doesn’t work. It is merely a theatrical placebo based on pre-scientific myths.

All health care providers who accept that they should base their treatments on scientific evidence whenever credible evidence is available, but who still include acupuncture as part of their health interventions, should seriously revise their practice.

There is no place for acupuncture in Medicine.

I, of course, agree wholeheartedly with FSM that there is no place for acupuncture in science-based medicine, but I must quibble with FSM on one point. Acupuncture, unfortunately, is not “losing support in medicine,” at least not in the US. Rather, it is, at the very least, remaining popular, if not outright gaining support; indeed, of all the quackery in CAM that is out there, acupuncture is the one with the most “respectability.” You can find it being offered in “integrative medicine” programs in most academic medical center in the US, including some of the most prestigious, like the Memorial Sloan-Kettering Cancer Center, M.D. Anderson Cancer Center, Stanford University, and many more. It’s also offered in most large private health systems as well. Currently, 45 states plus the District of Columbia license acupuncturists, and, as Jann Bellamy noted last week, in their quest for licensure in all 50 states, acupuncturists scored a victory in Kansas, winning licensure with a very broad scope of practice. According to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), in California alone, there are over 10,000 licensed acupuncturists, and a total of nearly 28,000 licensed acupuncturists in the US, although the number of active diplomates is considerably lower.

While FSM is correct that acupuncture is often included with a slate of other pseudoscientific medical interventions, it is still the one form of quackery accepted as potentially plausible by most doctors (or perhaps as least implausible). Perhaps it’s because it involves sticking actual needles into the body, but for whatever reason, there appears to be the least resistance to acupuncture and any medical center, academic or private, that has an integrative medicine program almost certainly offers acupuncture. For that reason there is a lot of interest in studying acupuncture, which will inevitably lead to more dubious studies, particularly because the physical act of inserting needles allows for all sorts of questionable hypotheses explaining how acupuncture “works,” facilitating its “integration” into quackademic medicine.

Indeed, studies like the one I deconstructed in this post are part and parcel of the “evidence base” for acupuncture, as FSM has noted in its magnificently thorough discussion of acupuncture. Unfortunately, acupuncture is now so well-entrenched in “integrative medicine” programs that it will be incredibly difficult to dislodge.

from ScienceBlogs http://ift.tt/2aeobIT

Many are the bizarre, dubious, and downright crappy acupuncture studies that I’ve deconstructed over the years. Just type “acupuncture” into the search box of this blog, and you’ll soon see. (If that pulls up too many results, try typing “acupuncture” and “study” or “acupuncture” and “clinical trial” in the search box.) I’m not the only one, either. For instance, my good bud Mark Crislip did his usual excellent and highly sarcastic job of deconstructing the frequent claim by acupuncture apologists that acupuncture “works” by releasing endorphins. So when I first saw an even more bizarre acupuncture study than usual, I knew I’d have to take it on sooner or later. Then last week, the Friends of Science in Medicine sent me a link to their latest article, a review of acupuncture entitled “Is there any place for acupuncture in 21st century medical practice?” Not surprisingly, the FSM (Friends of Science in Medicine, not the Flying Spaghetti Monster) concludes that the answer is no. However, in stark contrast to that conclusions are studies like the one mentioned above, studies so ridiculous that, when I discuss it, you will hardly believe that anyone thought it was a good idea to utilize the money, time, and precious, precious human subjects to answer such a ridiculous question. After that discussion, I’ll come back to the FSM’s statement and discuss the evidence base (or rather, lack thereof) for acupuncture for pretty much anything.

Emergency acupuncture!

As Mark noted, one of the most commonly invoked “explanations” (other than that it “releases adenosine” such that acupuncture apologists have tried to rebrand regional anesthesia as acupuncture based on this concept) is that acupuncture somehow stimulates the release of endorphins, natural, endogenous substances that suppress the sensation of pain. Based on dubious science, acupuncture apologists are frequently seen touting its benefits and explaining them to credulous media outlets such as Consumer Reports. Indeed, it’s amazing how far acupuncture apologists will go to justify their beliefs, frequently mislabeling TENS as acupuncture. Since endorphins are basically neurotransmitters (substances that transmit a chemical message from neuron to neuron or neuron to muscle) that stimulate the same receptors as morphine, namely opioid receptors, they function as a natural system to decrease the sensation of pain, among other functions. There are basically four types of endorphins: alpha (α), beta (β), gamma (γ) and sigma (σ), all of them peptides and distinguished by having different numbers and types of amino acids making up their structure. To put it simply, opioid pain relievers like morphine or Fentanyl mimic natural endorphins. There’s a lot of woo out there whose advocates invoke endorphins, basically any “complementary and alternative medicine” (CAM) that claims to reduce pain or make one feel better.

Enter emergency acupuncture. No, I’m not kidding you. Instead of battlefield acupuncture, which is helping to pave the way for acupuncture to infiltrate the VA Medical Center system, here we have a clinical study examining the use of acupuncture in the emergency room, published in The American Journal of Emergency Medicine, entitled “Acupuncture versus intravenous morphine in the management of acute pain in the emergency department.” No, I kid you not. Click on the link if you don’t believe me. This is a clinical trial randomizing people with acute pain to acupuncture versus intravenous morphine. Its ClinicalTrials.gov identifier is NCT02460913.

Let’s take a look at this study.

It is a phase 2 clinical trial that randomizes patients in the emergency room with acute pain to either titration of intravenous morphine or acupuncture. As you can probably imagine, it is completely unblinded. There is no sham, nor is there even an attempt at blinding. Given that, I bet you can guess the result before I even describe the study in more detail, because the results of such a study are very predictable. Let’s move on, anyway.

First, how do the investigators, who are based at two different hospitals in Tunisia affiliated with the University of Monastir, justify their study? First, they invoke a systematic review of acupuncture use in the emergency department, which, amazingly, found 102 studies. Not amazingly, only two RCTs and two uncontrolled observational studies were deemed eligible. Also not surprisingly, in line with the methodolatry that characterizes evidence-based medicine (EBM), the authors concluded that “current evidence is insufficient to make any recommendations concerning the use of acupuncture in the ED” and recommended that the “effectiveness and safety as well as the feasibility of acupuncture should be tested in future RCTs.” Of course, the science-based medicine (SBM) retort to this conclusion is that, given the extreme lack of prior plausibility of acupuncture, coupled with such equivocal clinical evidence, the most parsimonious explanation is that acupuncture doesn’t work.

Not to these investigators:

The World Health Organization (WHO) has recognized acupuncture as a safe and effective therapy for a myriad of conditions causing pain and discomfort [4]. However, the introduction of acupuncture in the treatment of pain in the ED is rare. Acupuncture was shown to be as effective as morphine and it has a better safety profile which makes it a suitable method of pain control in certain circumstances such as headaches, migraines, back pain, cervical pain and osteoarthritis [5].

Again, that damned WHO report. Basically, it was a report written by acupuncturists who made statements at odds with the evidence. Actually, in this case, the authors referenced a 2002 acupuncture report that appears to be an update to the original that acknowledges the “debt” to the acupuncturists who authored the original report. In any case, the rationale for using acupuncture in the emergency room is, as you would expect, quite weak.

Now let’s take a look at the study design, specifically the two interventions. The first part that sends up a red flag to me is this:

Patients were screened for inclusion in the triage unit during the day between the hours of 8 a.m. to 7 p.m., Monday through Friday. Eligible patients were those who presented for moderate to severe acute onset pain with stable clinical conditions that did not require any resuscitation measures or specific procedures except for treatment of painful condition.

That sounds fair enough at first, but think about it a bit more. Basically, anyone in pain could be randomized, as long as they didn’t have a clinical condition that needed immediate treatment, rather only “treatment of painful condition.” Now here’s the rub. Look at the inclusion criteria:

Patients were included in the protocol if they were aged ≥18 years and met the following criteria: Acute onset pain <72 hours of the ED presentation, pain intensity ≥40 of the VAS or NRS (ranging from 0 for no pain to 100 for maximum imaginable pain), acute musculoskeletal pain with no evidence of fracture or dislocation, including ankle and knee sprains without signs of severity (ligament rupture, laxity), shoulder and elbow tendinitis, upper and lower limb mechanical pains and lower back pain with no evidence of neurological deficit, acute abdominal pain with no urgent surgical intervention including renal colic and dysmenorrhea and acute headache that meets the criteria of primary headache, as described by the international headache society [7].

As you will see later, these criteria lead to some real problems with the study, but I’ll forego discussion of that aspect until I get to the results in favor of pitching a TV show to Lifetime called “Emergency Acupuncturists!” Don’t worry, I’ll get back to this problem soon enough, but I will hint now that the mix of patients in each group was not comparable. I’ll also mention that if I came in with pain from a kidney stone, there’s no way in hell that I would let an acupuncturist near me or agree to be randomized.

The other major problem with the study design, as I discussed before, is that it is completely unblinded. Patients, doctors, acupuncturists, everyone knew which group the patient was in. This sort of design is almost guaranteed to produce a result in which the acupuncture group shows a high degree of pain relief, thanks to placebo effects. Whether that pain relief will be more, less, or the same as the standard of care to which acupuncture is being compared varies depending on the study, but I rarely go wrong predicting that an unblinded acupuncture study will show a lot of benefit for acupuncture, sometimes even the same as or greater than standard of care.

Now let’s look at the two interventions. First, the acupuncture:

After allocation to this group, patients were redirected to the ED acupuncture unit. The acupuncturist was an ED doctor with medical acupuncture qualification accredited by the National Tunisian Council of Doctors with 10 years experience in the field. Treatment protocols were determined through review of major clinical manuals and textbooks, literature review, and a panel of specialist acupuncturists from Chinese medicine backgrounds [8]. The protocols, which allow acupuncture points to be selected from a pool of pre-determined points for each condition, provide sufficient standardization to assist replication, yet are flexible enough to allow individualized treatments. These protocols also allow for additional points, such as ‘ashi points’, to be used at the discretion of the acupuncturist. The location of the points, angle of insertion and depth of insertion were sourced from a popular text “A Manual of Acupuncture” [9] and described in the annexe table (annexe1). The average time to place needles is five minutes.

So basically acupuncturists could choose any points they wished. Of course, as I’ve pointed out before, acupuncture “works” (i.e., produces placebo effects) whether you put the needles into the “right” points or not. It doesn’t even matter if you actually insert the needles, as long as you touch the skin (even with toothpicks instead of needles)! Be that as it may, there was not even an attempt to include a sham acupuncture group.

The morphine group involved titrating morphine, starting with a dose of 0.1 mg/kg and repeating the morphine at 0.05 mg/kg every five minutes until the desired decrease in pain was achieved, with a maximum total dose being 15 mg. This is a fairly standard ER protocol for treating acute pain, although other evidence suggests that a titration scheme using a protocol with an initial dose of 2 mg (body weight < 60 kg) or 3 mg (body weight > 60 kg) with subsequent administration of 3 mg of morphine every 5 minutes until desirable or adverse effects occurred is more effective. Be that as it may, we are basically seeing a test of acupuncture versus one widely utilized protocol for dosing morphine for acute pain. Also, patients were allowed to receive other treatments suitable to their conditions if judged necessary, such as ice application, compression, elevation and rest. It wasn’t clear to me if this was also the case with the acupuncture arm.

So what were the results? Here you go:

Success rate was significantly different between the two groups (92% in the Acupuncture group vs. 78% in the Morphine group P < .01). Resolution time was 16 ± 8 minutes in the acupuncture group vs. 28 ± 14 minutes in the morphine group. The difference was statistically significant (P < .01). The mean absolute difference in pain score between the two groups was 7.7. This difference is not clinically significant since the minimal clinically significant absolute difference reported by Todd et al. is 13. In Morphine group the mean total dose of Morphine administered was 0.17 ± 0.08 mg/Kg (Table2).

I’ll give the investigators credit for mentioning that a statistically significant difference does not necessarily mean a clinically significant difference in pain scores. I only wish Andrew Vickers would learn this lesson instead of attacking those who criticize his work. One also notes that a titration scheme like the one above to reduce acute pain using morphine will likely take at least 20 minutes, given that it consists of administering subtherapeutic doses of morphine, assessing reduction in pain after five minutes, and then giving an even smaller dose, rinse, lather, repeat. The reason for this, of course, is that morphine can depress respiration and decreased blood pressure, which is why clinicians need to be cautious, but such an approach inherently takes longer.

Excuses and incomparable (uncomparable?) groups!

Now, I’ll revisit what I alluded to earlier about an uneven distribution of conditions. It’s hard not to note in Table 1 that there were significantly more abdominal pain patients in the morphine group (79) than the acupuncture group (60) and that there were significantly fewer low back pain patients (27 in the morphine group vs. 44 in the acupuncture group). Given that in general we try to avoid opioids for low back pain and that low back pain often resolves with relaxation and rest, one has to wonder if these skewed the results. Similarly, the most common condition causing abdominal pain that doesn’t require immediate surgery for which it is safe to administer opioid analgesics is likely to be kidney stones, which are extremely painful and not likely to pass quickly. Given that patients with abdominal pain were the single largest group in this trial, making up close to half the total patients, one wonders why the authors didn’t break out the pain scores for this group, given that there was such an imbalance between the groups. It also concerns me that this ER is administering morphine for so many people with abdominal pain. While that is appropriate for kidney stones, it is seldom, if ever, appropriate for dysmenorrhea (painful menses).

Also, there is a big problem with the reporting of this clinical trial, so much so that I’m surprised this journal published it. There is no CONSORT flow diagram to show allocation of subjects, dropout rates, and analysis. Indeed, seeing a clinical trial in which there are exactly 150 subjects in each arm always makes my skeptical antennae start twitching. No one dropped out of the study? No one was randomized but decided not to go through with the trial? I suppose it’s possible for a short term intervention in the ER, but consider this: Accrual was exactly perfect for each group. This almost never happens in a clinical trial.

Finally, the authors try to excuse their lack of blinding:

First, the main flow of this trial is the lack of blinding. In fact, in these settings sham acupuncture has been proposed to provide a comparable experience to the study subjects and to minimize the effects of nonblinding. However, in our study sham acupuncture use would be impossible given the workload of a single acupuncturist.

I’m sorry, but there is no excuse here. If you can’t properly blind the subjects and the practitioners, then you shouldn’t even bother to do the trial, because it will be crap. Actually, the authors’ failure in blinding is double. Here’s how I would have designed the trial:

• Morphine titration + sham acupuncture
• Placebo morphine (i.e., normal saline injections) + acupuncture

This way, both patients get what they believe to be an identical experience, and you can compare acupuncture to morphine in this setting. Of course, the better design would have two more groups:

• Morphine titration + acupuncture
• Placebo morphine (i.e., normal saline injections) + sham acupuncture

If this were a study of acupuncture for a more chronic condition, I’d incorporate some sort of crossover design, but it isn’t; so I won’t.

Having these four groups would allow a complete analysis of the two interventions with far less potential for bias and placebo effects. However, in a pinch, if there aren’t resources to recruit patients for four groups like this, just including the first two groups would do nicely for a pilot project. Of course, this is an EBM standpoint. From an SBM standpoint, in which basic biology indicates a prior plausibility for acupuncture that is incredibly low, I would judge this study not worth doing, but I’d also say that if you insist on doing it anyway you should at least do it right.

Unfortunately, such is the quality of the vast majority of acupuncture studies, which brings us to the FSM statement.

Acupuncture is pointless

The FSM paper is an excellent primer on why acupuncture is pseudoscience. I encourage you to read the whole thing; I’ll only hit the highlights. First, they point out exactly what I’ve been saying about traditional Chinese medicine (TCM) for years and years now:

TCM, also present in Japan, where it is called Kampo, is, together with Indian Ayurveda and pre-Enlightenment European medicine, one of the major pre-scientific medicines. They share common roots, probably from ancient Indian philosophies, according to which the equilibrium of the healthy human body is believed to be the result of a balance of a number of elements. Diseases are thought to be due to their imbalance.

In TCM, these elements are wood, water, fire, earth and metal, a belief similar to that of ancient Indian Unani medicine, with its four humours (akhlaat) – air, earth, fire and water, and Indian Ayurveda medicine’s air, water and fire. Pre-scientific European (from Greco-Roman) medicine proposed four humours, each associated with the four natural universal elements (blood – air; phlegm – water; yellow bile – fire; black bile – earth). Although these theoretical constructs represented an initial attempt to unify knowledge about the world and ourselves, none has any scientific foundation.

This is exactly why I like to ask: Where’s the love for traditional European medicine? Teach the controversy, I say:

Many of the points (get it—”points,” acupuncture?) made by FSM are points familiar to regular readers of SBM. Acupuncture is not really ancient, given that early Chinese medical texts don’t mention it. It appears to have been more based on lancing abscesses with a larger lance and ancient bloodletting not unlike what was practiced in Europe, possibly with a bit of astrology added. Even as recently as 103 years ago, acupuncture was practiced in a barbaric fashion with very large needles, often heated, left in the body for days, sometimes resulting in death. Then, of course, there was the retconning of TCM by Chairman Mao Zedong, who didn’t really believe in TCM but didn’t have the resources to bring SBM to his entire country. So he tried to “integrate” TCM into modern medicine and dispatched hordes of “barefoot doctors” practicing TCM to fill in the breach. Then, starting in the 1960s and 1970s, stories of the wonders of acupuncture filtered to the West from China, thanks to credulous journalists.

Then there’s the veritable catalog of proposed “mechanisms” by which acupuncture “works,” including adenosine (wrong) and endorphins (again, wrong). Add to that the variability in studies, the oft-repeated observation that it doesn’t matter where you stick the needles or even if the needles pierce the skin, and it becomes clear that acupuncture is merely “theatrical placebo.” As Steve Novella likes to point out, the better designed the study, the more likely it is to show no discernable effect attributable to acupuncture greater than placebo effects. No wonder acupuncturists like unblinded studies.

Is there any justification for the use of acupuncture in modern medicine?

FSM concludes by asking the question: Is there any justification for the use of acupuncture in modern medicine? You know our answer here at SBM, but it’s worth quoting FSM:

As acupunctures loses support in Medicine, it is increasingly used as part of larger constellations of alternative treatments within private enterprises which mix together, almost randomly, any of the many pseudoscientific interventions under a generally attractive umbrella of ‘wellness’. This makes acupuncture even less reliable and hides it from public scrutiny.

Acupuncture has been studied for decades and the evidence that it can provide clinical benefits continues to be weak and inconsistent. There is no longer any justification for more studies. There is already enough evidence to confidently conclude that acupuncture doesn’t work. It is merely a theatrical placebo based on pre-scientific myths.

All health care providers who accept that they should base their treatments on scientific evidence whenever credible evidence is available, but who still include acupuncture as part of their health interventions, should seriously revise their practice.

There is no place for acupuncture in Medicine.

I, of course, agree wholeheartedly with FSM that there is no place for acupuncture in science-based medicine, but I must quibble with FSM on one point. Acupuncture, unfortunately, is not “losing support in medicine,” at least not in the US. Rather, it is, at the very least, remaining popular, if not outright gaining support; indeed, of all the quackery in CAM that is out there, acupuncture is the one with the most “respectability.” You can find it being offered in “integrative medicine” programs in most academic medical center in the US, including some of the most prestigious, like the Memorial Sloan-Kettering Cancer Center, M.D. Anderson Cancer Center, Stanford University, and many more. It’s also offered in most large private health systems as well. Currently, 45 states plus the District of Columbia license acupuncturists, and, as Jann Bellamy noted last week, in their quest for licensure in all 50 states, acupuncturists scored a victory in Kansas, winning licensure with a very broad scope of practice. According to the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), in California alone, there are over 10,000 licensed acupuncturists, and a total of nearly 28,000 licensed acupuncturists in the US, although the number of active diplomates is considerably lower.

While FSM is correct that acupuncture is often included with a slate of other pseudoscientific medical interventions, it is still the one form of quackery accepted as potentially plausible by most doctors (or perhaps as least implausible). Perhaps it’s because it involves sticking actual needles into the body, but for whatever reason, there appears to be the least resistance to acupuncture and any medical center, academic or private, that has an integrative medicine program almost certainly offers acupuncture. For that reason there is a lot of interest in studying acupuncture, which will inevitably lead to more dubious studies, particularly because the physical act of inserting needles allows for all sorts of questionable hypotheses explaining how acupuncture “works,” facilitating its “integration” into quackademic medicine.

Indeed, studies like the one I deconstructed in this post are part and parcel of the “evidence base” for acupuncture, as FSM has noted in its magnificently thorough discussion of acupuncture. Unfortunately, acupuncture is now so well-entrenched in “integrative medicine” programs that it will be incredibly difficult to dislodge.

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A climate scientist and economist made big bucks betting on global warming

Climate scientist James Annan and climate economist Chris Hope made a nice sum this year for a bet they made on global warming in 2008. As Hope tells the story:

The record warmth of 2015 just made me £1,334 richer. While the extra cash is a nice bonus, it sadly demonstrates that the atmospheric dice remain loaded towards increasing climate change.

So, how did I turn increasing temperatures into cash? About five years ago I was at a conference in Cambridge where most of the participants were sceptical about the influence of humans on the climate. I took the microphone and asked if any of them would care to make a £1,000 bet with me about whether 2015 would be hotter than 2008. Two brave souls, Ian Plimer and Sir Alan Rudge, agreed.

Like a good economist, Hope hedged his bets. Plimer and Rudge had given him even odds, and Hope found a climate scientist, James Annan, who gave him 4-to-1 odds on the opposite wager:

I asked him what odds he would give me. In 2011, he was confident enough in the reality of climate change to offer me odds of 4 to 1 against 2015 being cooler than 2008 ... now I was perfectly hedged: I would win £1,333 if 2015 were cooler than 2008, and £1,334 if it were warmer.

2015 was of course hotter than 2008, so Plimer and Rudge each lost £1,000, with £1,334 going to Hope and £666 going to Annan on Hope’s hedged bet.

A particularly foolish bet by the GWPF advisors

While research has shown that betting against global warming is generally a great way to lose money, this particular bet was especially foolish. 2008 saw a strong La Niña event, which cause ocean surface and therefore global surface temperatures to temporarily cool. It was the coolest year since 2000 - what mathematicians call a “local minimum” because the temperature was lower than all the nearby years. And the bet was made about 5 years ago, so the participants knew that.

Between 2008 and 2015 there would be more than 0.1°C of human-caused global warming, so for 2015 to be cooler would have required a huge La Niña event, or big volcanic eruption, or perhaps the contrarians were banking on human-caused global warming being wrong. 

Whatever their reasoning, it was a foolish bet to make. 2015 was a record-breaking hot year, about 0.32°C hotter than 2008. It wasn’t even close. In fact, it’s quite possible that we won’t see another year as cool as 2008 in our lifetimes. 2011 saw a big La Niña event, but it was still significantly warmer than 2008. The further away that year gets in the rear-view mirror, the more global warming humans are causing, and the less likely we’ll see another year as cool as 2008.

It’s worth noting that the two individuals who made this bet - Ian Plimer and Alan Rudge - are both members of the Global Warming Policy Foundation academic advisory board. The GWPF is a UK anti-climate advocacy group that generally relies upon unreliable sources of climate information. That their advisors make such foolish wagers does not inspire confidence in the group.

Climate scientists dare deniers: put your money where your mouth is

It’s easy for those who deny the threats associated with human-caused global warming to talk a big game. For their efforts they’re often paid handsomely viathe web of denial, media outlets that practice false balance give them undeserved prominence, and in most cases they’re old men who won’t live to see the worst consequences resulting from their efforts to delay climate action.

Climate scientists want to change this by engaging them in more bets like Hope’s.My colleagues and I managed to engage a group of contrarians in a wager that in the satellite estimates of the temperature of the Earth’s lower atmosphere, 2011–2020 (so far, a 0.27°C anomaly) will be hotter than 2001–2010 (0.22°C). Our side was willing to put up nearly three times more money (for charity) than the contrarians. Not surprisingly, we already have a comfortable lead.

At this year’s American Geophysical Union conference - the largest gathering of climate scientists in the world - several scientists are holding a session on this very topic (Annan is one of the invited speakers):

Click here to read the rest

from Skeptical Science http://ift.tt/2aNZP6X

Climate scientist James Annan and climate economist Chris Hope made a nice sum this year for a bet they made on global warming in 2008. As Hope tells the story:

The record warmth of 2015 just made me £1,334 richer. While the extra cash is a nice bonus, it sadly demonstrates that the atmospheric dice remain loaded towards increasing climate change.

So, how did I turn increasing temperatures into cash? About five years ago I was at a conference in Cambridge where most of the participants were sceptical about the influence of humans on the climate. I took the microphone and asked if any of them would care to make a £1,000 bet with me about whether 2015 would be hotter than 2008. Two brave souls, Ian Plimer and Sir Alan Rudge, agreed.

Like a good economist, Hope hedged his bets. Plimer and Rudge had given him even odds, and Hope found a climate scientist, James Annan, who gave him 4-to-1 odds on the opposite wager:

I asked him what odds he would give me. In 2011, he was confident enough in the reality of climate change to offer me odds of 4 to 1 against 2015 being cooler than 2008 ... now I was perfectly hedged: I would win £1,333 if 2015 were cooler than 2008, and £1,334 if it were warmer.

2015 was of course hotter than 2008, so Plimer and Rudge each lost £1,000, with £1,334 going to Hope and £666 going to Annan on Hope’s hedged bet.

A particularly foolish bet by the GWPF advisors

While research has shown that betting against global warming is generally a great way to lose money, this particular bet was especially foolish. 2008 saw a strong La Niña event, which cause ocean surface and therefore global surface temperatures to temporarily cool. It was the coolest year since 2000 - what mathematicians call a “local minimum” because the temperature was lower than all the nearby years. And the bet was made about 5 years ago, so the participants knew that.

Between 2008 and 2015 there would be more than 0.1°C of human-caused global warming, so for 2015 to be cooler would have required a huge La Niña event, or big volcanic eruption, or perhaps the contrarians were banking on human-caused global warming being wrong. 

Whatever their reasoning, it was a foolish bet to make. 2015 was a record-breaking hot year, about 0.32°C hotter than 2008. It wasn’t even close. In fact, it’s quite possible that we won’t see another year as cool as 2008 in our lifetimes. 2011 saw a big La Niña event, but it was still significantly warmer than 2008. The further away that year gets in the rear-view mirror, the more global warming humans are causing, and the less likely we’ll see another year as cool as 2008.

It’s worth noting that the two individuals who made this bet - Ian Plimer and Alan Rudge - are both members of the Global Warming Policy Foundation academic advisory board. The GWPF is a UK anti-climate advocacy group that generally relies upon unreliable sources of climate information. That their advisors make such foolish wagers does not inspire confidence in the group.

Climate scientists dare deniers: put your money where your mouth is

It’s easy for those who deny the threats associated with human-caused global warming to talk a big game. For their efforts they’re often paid handsomely viathe web of denial, media outlets that practice false balance give them undeserved prominence, and in most cases they’re old men who won’t live to see the worst consequences resulting from their efforts to delay climate action.

Climate scientists want to change this by engaging them in more bets like Hope’s.My colleagues and I managed to engage a group of contrarians in a wager that in the satellite estimates of the temperature of the Earth’s lower atmosphere, 2011–2020 (so far, a 0.27°C anomaly) will be hotter than 2001–2010 (0.22°C). Our side was willing to put up nearly three times more money (for charity) than the contrarians. Not surprisingly, we already have a comfortable lead.

At this year’s American Geophysical Union conference - the largest gathering of climate scientists in the world - several scientists are holding a session on this very topic (Annan is one of the invited speakers):

Click here to read the rest

from Skeptical Science http://ift.tt/2aNZP6X