Is acupuncture really ancient Chinese medicine? Does it work? Is it safe?
This ancient Chinese medical tradition stretches back over 3,000 years, the wisdom of the ancients producing medically valid results even today. As in antiquity, slender needles are inserted at precise meridian points on the body and manipulated by a skilled practitioner. Each acupuncture point relates to a specific organ or function in the body, and the practice manipulates the body’s energy, or qi to manage pain and treat a host of conditions including allergies, asthma, headaches, sciatica, insomnia, depression, high blood pressure, fibromyalgia, constipation, and even sexual dysfunction. Acupuncture is, in short, a venerable medical miracle.
Or is it? Let’s cast a skeptical eye at one of the most popular “alternative” medical modalities in the modern world.
Exactly how ancient is acupuncture? Not nearly as ancient as you may think. The first clue is right there in the hands of the acupuncturist: Those slender, flexible, stainless steel needles. The technology to make them didn’t even exist until about 400 years ago.
There are even more historical clues. The Chinese have long kept detailed records. When we examine them we do, indeed, find references to a practice called needling, but the earliest dates to about 90 BCE. The needles from that era were large, and the practice of needling refers to bloodletting and the lancing of abscesses, a treatment nothing like today’s acupuncture. Earlier Chinese medical texts, some reaching back to the 3rd century BCE, never even mention it. There’s no evidence at all that acupuncture is anywhere near 3,000 years old.
No matter. At least acupuncture is Chinese, right? Maybe not.
Chinese scholar Paul Unschuld thinks that the practice may have started in ancient Greece, with Hippocrates of Cos, and later spread to China. A fundamental feature of acupuncture, namely the special meridian points where the needles must be placed, can be traced to the medieval Islamic and European ideas of astrology mapped onto the body. This rather obvious link led researcher Ben Kavoussi to call acupuncture “Astrology with needles” He writes:
…for most of China’s long medical history, needling, bloodletting and cautery were largely practiced by itinerant and illiterate folk-healers, and frowned upon by the learned physicians who favored the use of pharmacopoeia.
Accounts of Chinese medicine first reach Europe in the 13th century. None of them even mentioned acupuncture. Wilhelm Ten Rhijn, writing in 1680, was the first Westerner to reference acupuncture. But what he described bears little resemblance to the acupuncture of today. There was no mention of qi, which is sometimes translated as chi, or any specific points. He spoke of large gold needles that were implanted deep into the skull or womb and left in place for 30 respirations.
The first American acupuncture trials were in 1826, when it was seen as a possible method of resuscitating drowning victims. As Dr. Harriet Hall describes it, “They couldn’t get it to work and ‘gave up in disgust.’ I imagine sticking needles in soggy dead bodies was pretty disgusting.”
Even through the early part of the 20th century nobody spoke of qi or meridians. Practitioners merely inserted needles near the point of pain. In fact, qi used to refer to the vapor arising from food, and the meridians were called channels or vessels, which is part of acupuncture’s link to medieval astrology and vitalism.
So just when and where did meridians enter the picture, and qi finally become some kind of energy?
I usually don’t dwell too much on chiropractic, because so many other bloggers mock them so well. Chiropractors are generally antivaccination, they practice junk medicine in areas in which they are not trained, and they are essentially quacks utilizing some mystical alternative medicine, taking money from people who think they’re getting real medical treatment.
Basically, chiropractic is the belief in the “vertebral subluxation processes” that purportedly can be used to treat and cure a vast range of diseases which have no scientifically verified connection to vertebral anatomy. It’s based on the same general type of pseudoscientific mysticism that one finds with acupuncture.
Of course, modern chiropractic has tried to divorce itself from the vertebral subluxation, and attempted to evolve into the slightly more mainstream chiropractic treatment technique that involves manual therapy, including manipulation of the spine, other joints, and soft tissues. Chiropractic treatment also includes exercises and health and lifestyle counseling. Barely anything more than a good masseuse would provide to an individual.
Despite this evolution of chiropractic to the point that some health insurance companies actually pay for the procedures, chiropractic is a typical pseudoscience–make outlandish claims, minimize or ignore the risks, and make money off of those who think, or want to believe, that it works.
It’s appalling that some people, many who think that vaccines are dangerous (they’re not), believe that a chiropractor, who has very little real medical training, should manipulate the neck of a baby to treat some imaginary, or even real, condition. It boggles the mind.
So, what does real science say about chiropractic?
Alternative Medicine’s best friend, and in my opinion largely responsible for what popularity it has, is a gullible media. I had thought we were turning a corner, and the press were over the gushing maximally clueless approach to CAM, and were starting to at least ask some probing questions (like, you know, does it actually work), but a 2006 BBC documentary inspires a more pessimistic view.
The documentary is part of a BBC series hosted by Kathy Sykes: Alternative Medicine, The Evidence. This episode is on acupuncture. The episode is from 2006, but was just posted on YouTube as a “2014 documentary.” Unfortunately, old news frequently has a second life on social media.
First, let me point out that Sykes is a scientist (a fact she quickly points out). She is a physicist, which means that she has the credibility of being able to say she is a scientist but has absolutely no medical training. It’s the worst case scenario – she brings the credibility of being a scientist, and probably thinks that her background prepares her to make her own judgments about the evidence, and yet clearly should have relied more on real experts.
She does interview Edzard Ernst in the documentary, but he mainly just says generic statements about science, rather than a thorough analysis of specific claims. I wonder what gems from him were left on the cutting room floor.
The documentary does get better in the second half, as she starts to mention things like placebo effects, and the problems with the evidence-base for acupuncture. But she follows a disappointing format – setting up a scientific premise, then focusing on the positive evidence. There is a clear narrative throughout, that acupuncture is amazing and surprising.
Another improperly done and ineptly reported acupuncture study has appeared. Julie Medew is the health editor for The Age, an Australian newspaper with an online presence. She authored an article yesterday with the headline:
The headline is accurate but falsely implies that acupuncture was effective, which most people will probably take to mean that acupuncture, by some as yet undiscovered means, really relieves pain. Many people will also jump to the conclusion that this is a good thing because drugs have side effects and acupuncture doesn’t. Is that true? It’s not obviously true or intuitively true. We need evidence before we should accept such a claim. Many people will also jump to the conclusion that this is a good thing because acupuncture is cheaper than pain pills. Is that true? If it is, it is not obviously true or intuitively true. Where’s the evidence?
Anyway, the study was done by the Royal Melbourne Institute of Technology’s [RMIT] school of health sciences in conjunction with emergency physicians at four hospitals. I’d never heard of RMIT until yesterday. The website says it is a university and the health sciences webpage says:
The School of Health Sciences engages in teaching and research in Complementary Medicine, Nursing and Midwifery, and Psychology.
We recognise that many of the greatest advances in Science are made at the intersections of disciplines. With our strong interdisciplinary approach we have set our sights on establishing an evidence base for the quality, safety and effectiveness of interventions for the ageing population and those with chronic diseases. Our research findings inform clinical teaching and advance the treatment of patients.
One can only hope that the quality of research in other areas investigated by this institution is superior to that reported on by Ms. Medew. According to her, the “randomised controlled study of about 550 patients” gave acupuncture to some and a”strong oral analgesia, such as Endone, Panadeine Forte, Voltaren and Valium” to others. Medew reports that Dr Michael Ben-Meir “said it showed acupuncture offered the same level of pain relief as analgesic drugs when patients rated their pain one hour after treatment.” You read that right. The conclusion that acupuncture is as effective as pain pills was based on asking the patients about their pain level one hour after treatment. Was there a group of patients in the study who were give a dummy pain pill or fake acupuncture? No, but there was a group given both acupuncture and a pain pill. Guess what? After one hour, their reported pain level didn’t differ from those given only acupuncture or only a pain pill.
Baton Rouge, LA-When investigators climbed from out of the smoldering debris that was the home of Hank Thomas, the looks on their faces told the gathering crowd what these hardened veterans of the Baton Rouge Fire Department couldn’t put into words. Thomas, a yoga instructor and avid fisherman who had lived in Baton Rouge his entire life, had exploded. And as the grisly details slowly emerge, people are asking questions about what might be to blame and how they can prevent being the next Baton Rougian to erupt into a massive fireball of body parts and Tony Chachere’s Creole Seasoning.
Some local medical professionals have proposed a controversial theory. Based on reports that Thomas has undergone acupuncture treatments for sciatica several times in the weeks preceding his untimely fulmination, a group of local experts are speaking out. They are warning the community to beware of discount acupuncture clinics.
“We aren’t saying that every incidence of spontaneous human combustion is linked to the incorrect placement of acupuncture needles,” Kuang Zhu LAC, Chief of Pragmatic Acupuncture in the Health and Wellness division of Vic’s Day Spa and Pet Grooming Center, explained during a recent press conference. “But in some cases, there is a relationship that is hard to explain otherwise.”
Zhu, a legally licensed acupuncturist in Baton Rouge, Louisiana for over thirty years and founder of the “Know Your Needler!” campaign, is reaching out to the Baton Rouge community because of concerns that there are patients seeking care from unlicensed and poorly trained practitioners that don’t charge as much per session. “These rogue needle-wielding impersonators don’t fully grasp the power of acupuncture, acupressure, sonopuncture, electroacupuncture, cold laser therapy, or any of the other ancient techniques of stimulating specific acupoints. With great ability to heal, comes an equal ability to harm.”
Acupuncture, a component of Traditional Chinese Medicine developed sometime in the past 5,000 years, involves the insertion of small needles into specific points on the body in order to improve the flow of life energy or Qi. These points are found along meridians, major pathways in the body through which our life energy courses that are different from blood vessels, nerves and lymphatics in that Western science has been unable to locate them during anatomical investigation or with modern imaging techniques. When Qi is obstructed, it becomes stagnant and illness develops. Properly placed needles relieve this obstruction and improve our health in a number of ways. Needles placed haphazardly can, according to Zhu, lead to further obstruction, a worsening of one’s health, and perhaps even a fiery death.
Zhu states that the phenomenon of injury by inappropriate acupuncture is not new. He has seen countless milder cases over his three decades of practice in the United States. But the worst occurred during his childhood in China. “Neighborhood gangs and even local police forces would use purposefully incorrect acupuncture as punishment or as an interrogation enhancer,” Zhu revealed. “Once I saw a body with the hao zhen needles still inserted in acupoints I did not even know existed. Oh, the disharmony! My childhood ended that day. I’ve heard that the American military is even using acupuncture on the battlefield now.”
But not every local acupuncturist supports Zhu’s theory that excessive and erroneous needle placement is to blame for unexplained explosions of American citizens. Frank Grimes, a Baton Rouge chiropractor who incorporates acupuncture into his armamentarium of healing modalities, reminds us that correlation doesn’t always equal causation. “Yes, some of the remaining body parts have been found with needles still in them,” He admits. “But my concern is that linking acupuncture to spontaneous human combustion is akin to the claim that chiropractic manipulation of the neck causes strokes. Perhaps people who are already about to explode seek out acupuncture for symptomatic relief.”
At the heart of this issue for Zhu and his colleagues is the health of their community. He admits that acupuncture-induced detonation is likely rare despite the recent occurrence, and that most people who receive acupuncture from improperly trained practitioners will at most only experience mild stagnation of Qi.
- Improperly Performed Acupuncture Linked to Spontaneous Human Combustion (sciencebasedmedicine.org)
- Acupuncture as a migraine cure? (themigrainehelp.wordpress.com)
- Indian baby catches on fire – Spontaneous combustion or abuse? (doubtfulnews.com)
The pragmatic fallacy is committed when one argues that something is true because it works and where ‘works’ means something like “I’m satisfied with it,” “I feel better,” “I find it beneficial, meaningful, or significant,” or “It explains things for me.” For example, many people claim that astrology works, acupuncture works, chiropractic works, homeopathy works, numerology works, palmistry works, therapeutic touch works. What ‘works’ means here is vague and ambiguous. At the least, it means that one perceives some practical benefit in believing that it is true, despite the fact that the utility of a belief is independent of its truth-value.
The pragmatic fallacy is common in “alternative” health claims and is often based on post hoc reasoning. For example, one has a sore back, wears the new magnetic or takionic belt, finds relief soon afterwards, and declares that the magic belt caused the pain to go away. How does one know this? Because it works! There is also some equivocation going on in the alternative health claims that fall under the heading of “energy medicine,” such as acupuncture and therapeutic touch. The evidence pointed to often uses ‘works’ in the sense of ‘the customer is satisfied’ or ‘the patient improves,’ but the conclusion drawn is that ‘chi was unblocked’ or ‘energy was transferred.’
There is a common retort to the skeptic who points out that customer satisfaction is irrelevant to whether the device, medicine, or therapy in question really is a significant causal factor in some outcome. Who cares why it works as long as it works? You can argue about the theory as to why it works, but you can’t argue about the customer satisfaction or the fact that measurable improvements can be made. That’s all that matters.
It isn’t all that matters. Testimonials are not a substitute for scientific studies, which are done to make sure that we are not deceiving ourselves about what appears to be true. It is especially necessary to . . .
- Integrated Medicine (illuminutti.com)
- The Unsinkable Rubber Duck Of Alternative Medicine (acneeinstein.com)
- The fallacy of the middle ground (ourchangingclimate.wordpress.com)
- The Curious Case of Correlation ≠ Causation (sensitivecontext.com)
- Logical Fallacies (gpissues.wordpress.com)
About a year ago the editors of Anesthesia & Analgesia solicited a written debate on whether or not acupuncture is effective or simply an elaborate placebo. Four experienced acupuncture researchers agreed to write the pro-acupuncture article, Wang, Harris, Lin and Gan.
The article is fortunately published in open access, and so I can reprint it here (full article is below). What I think David and I convincingly demonstrated is that, according to the usual standards of medicine, acupuncture does not work.
Let me explain what I mean by that. Clinical research can never prove that an intervention has an effect size of zero. Rather, clinical research assumes the null hypothesis, that the treatment does not work, and the burden of proof lies with demonstrating adequate evidence to reject the null hypothesis. So, when being technical, researchers will conclude that a negative study “fails to reject the null hypothesis.”
Further, negative studies do not demonstrate an effect size of zero, but rather that any possible effect is likely to be smaller than the power of existing research to detect. The greater the number and power of such studies, however, the closer this remaining possible effect size gets to zero. At some point the remaining possible effect becomes clinically insignificant.
In other words, clinical research may not be able to detect the difference between zero effect and a tiny effect, but at some point it becomes irrelevant.
What David and I have convincingly argued, in my opinion, is that after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant.
In layman’s terms, acupuncture does not work – for anything.
This has profound clinical, ethical, scientific, and practical implications. In my opinion humanity should not waste another penny, another moment, another patient – any further resources on this dead end. We should consider this a lesson learned, cut our losses, and move on.
I suspect, however, human nature being what it is, that this will not happen anytime soon.
Read the entire article Acupuncture Is Theatrical Placebo (Anesthesia & Analgesia).
- A closer look at vitamin injections (illuminutti.com)
- Energy Medicine – Noise-Based Pseudoscience (illuminutti.com)
- A Skeptic’s Guide to the Mind (illuminutti.com)
- What You Need To Know About Acupuncture (thehealthandwellnesszone.com)
- The acupuncture debate – is it over? (scienceornot.net)
- Science-Based Medicine Ebooks, Volumes 7-12 Now Available (randi.org)
- Science Journalism (theness.com)
- The Science Behind Acupuncture As Treatment For Osteoarthritis (wholesomeone.com)