DEAR DR. ROACH: You have mentioned acupuncture as a treatment for several conditions. I have read otherwise. How strong is the evidence for its use? — R.L. ANSWER: The effectiveness of acupuncture for over 50 different medical conditions was reviewed by the Cochrane Collaboration, an evidence-based medicine group. Some of these show significant benefit; for example, acupuncture improves pain and function in people with fibromyalgia and osteoarthritis, when compared with placebo pills. Acupuncture also was better than doing nothing and better than some other treatments. On the other hand, the Cochrane group could not find enough evidence to say whether acupuncture is effective for many other conditions, such as depression or shoulder pain. More importantly, some authors have argued that the benefit from acupuncture is a placebo response, and that the apparent benefit of acupuncture compared with a placebo pill is merely that acupuncture is a more effective placebo than just a pill. There certainly is evidence that even surgery has a potential for a placebo response, and one interesting recent study showed that people with Parkinson’s disease got more improvement in motor skills from a placebo pill they were told cost $1,500 than they did with the identical placebo if they were told it cost only $100. This shows me that our minds have a tremendous ability to improve our bodies if we really believe we can. I think that to a very large extent, and perhaps entirely, the real benefits seen by people who undergo acupuncture are a manifestation of the placebo response. Acupuncture has far fewer side effects than many medications and helps people with a variety of conditions. Whether its effect is “real” or placebo is almost not an issue. *** DEAR DR. ROACH: Last year, I started getting Raynaud’s. I can remember from my youth that my father had it, so it didn’t seem too terrible. It’s not just the fingertips that turn white, but also some of my toes are affected. I asked people who know of it or have it how one gets this. What is the cause? No one knows. So I asked my doctor. Even he said he did not know. How do I get these episodes, and what can I do to prevent them? — R.S. ANSWER: Raynaud phenomenon is an exaggerated response to cold or stress, causing color changes in the skin of the fingers and toes. There is a long list of causes of Raynaud phenomenon. Often, no cause is ever found (in which case it is called primary Raynaud, which just means we don’t know what’s causing it). The most common known causes are the autoimmune rheumatic diseases, especially scleroderma, lupus and Sjogren’s syndrome. Hypothyroidism is an unusual cause, and some drugs can cause it as well. The current thinking is that primary RP is caused by abnormalities in the alpha receptors in blood vessels (alpha receptors respond to adrenaline and similar molecules). Keeping the whole body — and especially the hands — warm is the first step. Sudden temperature changes can trigger the effect. Warming the hands in warm water at the onset of an attack can stop it. Anxiety makes it worse, so a positive attitude can really affect this condition. Medications, such as amlodipine, may be necessary for prevention in more severe cases. *** Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].