Acupuncture

Totalwaste made a comment recently regarding acupuncture that prompted me to post a real response. For those who don’t know, acupuncture is claimed to be an ancient system of healing developed over thousands of years as part of chinese traditional medicine. The treatment supposedly restores the balance of chi – the universal energy that flows through you – by poking needles into special places on your body (no, not that special place). These are all mapped out according to ‘meridians’ that are about as real as the lines of latitude and longitude on the earth.

To give you some background, here is the official position of the National Council Against Health Fraud:

  • Acupuncture is an unproven modality of treatment;
  • Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge;
  • Research during the past 20 years has not demonstrated that acupuncture is effective against any disease;
  • Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, and other psychologic mechanisms;
  • The use of acupuncture should be restricted to appropriate research settings;
  • Insurance companies should not be required by law to cover acupuncture treatment;
  • Licensure of lay acupuncturists should be phased out.

The question of whether acupuncture ‘works’ is actually twofold, because there are really two assumptions here – that sticking needles in your body is helpful, and that sticking needles in specific points in your body is helpful. The latter is the easiest to falsify, so I’ll start with that. Obviously the simplest way to control an acupuncture study that seeks to prove the theory of acupuncture points is to have half your group get acupuncture in the prescribed places, and have the other half get poked with needles in any old place. Not surprisingly, this has been done. Also not surprisingly, the studies have found that it doesn’t really matter where you get poked with a needle. As i’m sure you expected, the explanation of chi and meridians is a load of rubbish.

This leaves us with the idea that sticking needles into your body is helpful, regardless of where you put them. This poses a difficulty in controlled testing – how do you trick someone into thinking that you’re sticking a needle into them when you’re not? And what aspect is it that’s actually causing the effect – the pain of inserting the needle and the resulting endorphins, the whole drawn out ritual of the thing, or just the observed ebb and flow of chronic pain? There have been some efforts to create a sham acupuncture needle that is similar to a magician’s trick knife, and a significant number of patients reporting believing that they had in fact been pierced when they had not. However, there have been criticisms of the validity of this, so we are left with the problem that it is exceedingly difficult to reliably double blind an acupuncture test. This is exacerbated by the studies coming out of China, where doctors are actually not allowed to control studies for the placebo effect because giving a patient a placebo is considered medically unethical. On top of everything, most of the ailments that acupuncture claims to treat, such as pain, are highly subjective and difficult to quantify across subjects.

That said, what studies have been done have lead us to believe that the mechanism that produces an apparently successful acupuncture session is a combination of the following:

  • Stimulating a release of endorphins
  • Providing a diversion (similar to pinching yourself to hold off nausea)
  • Psychological reasons – placebo effect, suggestion, confirmation bias etc

Either way the relief is temporary, which means that even if you feel better after a session, you’re never actually getting to the source of the problem, so you’ll keep experiencing the pain, and you’ll keep coming back and lining the acupuncturist’s pockets. Except in the case of ailments that are purely psychosomatic, you are far better off going to a real doctor and finding out what’s wrong with you, and how to fix it.

More reading:

NCAHF position paper on Acupuncture

Skepdic entry

Straight Dope article

Skeptics.org article

10 Responses to “Acupuncture”

  1. I have always been sceptic when it came to alternate medicines, but a few years ago I went for a few sessions of acupuncture (not for fun – I dislocated my shoulder). But the process made me re-evaluate my viewpoint of the whole process. At the end of the day, it did not cause any harm and I made a full recovery.

    Now I DO NOT attribute this recovery to the acupuncture sessions, I was also going for physiotherapy and deep tissue massage sessions. But I did find the acupuncture sessions to be very relaxing and I feel that it helped my recover (most probably in a purely psychosomatic manner).

    If my doctor told me that he was going to cure my cancer with acupuncture, I would tell him to get “lost”. But if he sent me for a few sessions while prescribing scientifically proven medical remedies, I would go and enjoy the incense.

    And I did not find the process to be painful in the slightest! I get more endorphins when I stub my toe…

  2. 🙂 i have to agree with holey – although i’m left wondering how much i simply enjoy having to sit still for an age with needles sticking out of me. forced meditation for the semi-spiritual?

    it would be nice to be able to think of it as actually helpful, but that’s going to be a tad more difficult now😦

  3. again, for both of you the benefit is psychological – you may have got as much benefit by having a really long, hot bath. If you go to an acupunturist in the same understanding as you step into a bath full of bubbles – that you’re just doing this to relax and you should still continue with real therapy – then i’m sure it is helpful in a way. As Holey point out, a lot of acupuncture is done in conjunction with other, ‘conventional’ treatments, often leading the patient to believe that it was the acupuncture that cured them, when in fact all it did was provide a distraction while the real medicine worked. It’s sad to say, but most modern medicine is impersonal, and works in a way we cannot intuitively understand. Getting stuck with needles can seem so much more active than just taking a pill and waiting, not to mention that the average visit to a GP doesn’t involve nearly as much personal attention. The difference is, the pill doesn’t need you to believe in it to work.

    I think the thing to take away from acupuncture is this – there is a physiological and psychological effect to the ritual and process of the thing, but it offers only temporary relief, and even then only to some people. If that is all you are looking for, then by all means be my guest. In fact, for some people who are highly suggestive, acupuncture works very well as a method for managing pain, and I would agree that if you are one of those people then it’s certainly a better idea that pumping yourself full of pain medication which can have serious side effects. But remember, acupuncture is like hypnosis – only a few people are really susceptible to the point where it has a strong effect, so it would be unethical to advocate it for everyone.

    But if you think that acupuncture is some mysterious modality of healing handed down through the centuries as the only surviving remnant of a school of medicine far superior to our modern one, then you are sorely mistaken.

  4. I’m firmly in favour of sticking needles into certain people. It certainly makes me feel better. Maybe this classifies as acupuncture-by-proxy?

  5. it already has a name – voodoo

  6. VooDoo is nice.
    Voodoo Rules.
    Voodoo is my hot hot sex!!!

    I was joking. Uf! my english is very very bad, but i liked your blog a lot. It’s very interesting.

    It’s cool, and I am the girl of the oranges (la niña de las naranjas)

    BE BLOGGER!!!

    LIBERTaD DE EXPRESIÓN!!!
    EXPRESS YOURSELF

  7. i am fascinated. i get quarantined as a potential blogspam source, but this makes it through?!?!!

  8. themaddoctor Says:

    I traumatized my wrist in 1995. Rest, NSAIDS and cortisone injection. Did not work. So I tried accupuncture since my health plan paid half. It didn’t casue pain except once and no ill effects, but can’t say it did anything otherwise. I had the tendon release surgery. Point is that my experience was no benefit. And if health plans pay for this crap, like chiroquackery, it only increases our costs for health care.

  9. jackal.eyes Says:

    In a graduate-level statistics course, a professor presented a study he had done through the school. The experiment measured the treatment effects of acupuncture on the “meridians” acupuncture off the “meridians,” and a health class. The groups receiving the needles faired statistically better than the one in the class. His conclusion: “Acupuncture is an effective treatment… regardless of treatment area.” I can just imagine the headline “Local Statistician finds Acupuncture an ‘effective treatment.'” First, the result is misleading; second, he’s comparing acupuncture to taking a class. Wouldn’t a sugar pill or saline injection be a more appropriate treatment control?

  10. As to the on and off meridian part of the study, a number of studies have done the same and every single one shows that the effects of the two are comparable. Which means that at most, we can confidently say that ‘the meridian theory is nonsense’ and ‘IF acupuncture has an effect beyond the placebo effect, it has something to do with the physiological or pschological reaction to being stuck with a needle’ – since that was the common factor. Nothing more, nothing less.

    Whether its effect is relevant as treatment or not depends on whether it’s greater than the placebo effect. If the meridian studies tell us that the effect has something to do with being stuck with needles, the correct placebo control is not NOT getting stuck with needles, its NOT getting stuck with needles BUT THINKING YOU ARE. And that’s a bit difficult to pull off.

    Using students going to health class is not a placebo control at all, never mind if it’s appropriate to the study, as i doubt the students believed they were being treated for anything while attending the class. At most, he could say that the acupuncture, meridian regardless, was more effective than doing NOTHING, but that doesn’t mean it’s more effective than a placebo, because even placebos are more effective than doing nothing. And you can’t test it against just any old placebo, like a sugar pill… it has to be the placebo that directly corresponds to the treatment. Fake pills for real pills. Sham needles for real needles.

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