Aug 25 2008

Why I Am Skeptical of Acupuncture

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Comments: 41

Acupuncture is the practice of placing very thin needles through the skin in specific locations of the body for the purpose of healing and relief of symptoms. This practice is several thousand years old and is part of Traditional Chinese Medicine. As practiced today it is often combined with other interventions, such as sending a small current of electricity through the needles or burning herbs on the acupuncture points (a practice called moxibustion).

Acupuncture has recently been transplanted to the West, riding the wave of tolerance for unscientific treatment practices marketed as “complementary and alternative medicine.” While advocates have been successful at pushing acupuncture into the culture, the scientific medical community has still not accepted the practice as a legitimate scientific practice. I count myself among those extremely skeptical of acupuncture. I outline here the reasons for my continued skepticism.

1) Acupuncture is a pre-scientific superstition

Proponents often cite acupuncture’s ancient heritage as a virtue, but I see it as a vice. Acupuncture was developed in a pre-scientific culture, before anything significant was understand about biology, the normal functioning of the human body, or disease pathology. The healing practices of the time were part of what is called philosophy-based medicine, to be distinguished from modern science-based medicine. Philosophy-based systems began with a set of ideas about health and illness and based their treatments on those ideas. The underlying assumptions and the practices derived from them were never subjected to controlled observation or anything that can reasonably be called a scientific process.

An example from Western culture of philosophy-based medicine was the humoral theory – the notion that health was the result of the four bodily humors being in proper balance while illness reflected one or more humors being out of balance. Treatments therefore sought to increase or decrease one or more of the humors (such as the practice of blood-letting) to re-establish balance. The humoral theory survived for several thousand years in Western societies, perpetuated by culture and the power of deception inherent in anecdotal evidence.

Acupuncture is based upon the Eastern philosophy of chi (also spelled qi), which is their name for the supposed life force or vital energy that animates living things. In Traditional Chinese Medicine (TCM) chi flows through pathways in the body known as meridians. Illness results from the flow of chi through the meridians being blocked, or by the two types of chi (yin and yang) being out of balance. Acupuncture is the practice of placing thin needles at acupuncture points, which are said to coincide with points at which meridians cross, to improve the flow and restore the balance of chi.

There is no more reason to believe in the reality of chi than there is in the four humors, or in the effectiveness of acupuncture than the effectiveness of blood letting.

2) Acupuncture lacks a plausible mechanism

Centuries of advancement in our understanding of biology has made the notion of life energy unnecessary. Further, no one has been able to detect life energy or formulate a scientifically coherent theory as to what life energy is, where it comes from, and how it interacts with matter or other forms of energy. Withn science, the vitalists lost the debate over a century ago.Without chi, there is no underlying basis for acupuncture as a medical intervention.

Recent attention given to acupuncture has attempted to bring it into the scientific fold by hypothesizing physical mechanisms for its alleged effects. For example, some proponents argue that the needles may stimulate the release of pain-killing natural chemicals, or relax tense muscles, or inhibit the conduction of pain through counter-irritation.

These potential mechanisms, while more plausible than the non-existent chi, remain speculative. Further, they would only explain a very non-specific effect of acupuncture (no better than rubbing your elbow after accidentally banging it against something hard). They might account for a temporary mild reduction in pain. Such mechanisms could not account for any of the medical claims made for acupuncture, or the alleged existence of acupuncture points.

Further, it is misleading to say that such mechanisms could explain “acupuncture.” Acupuncture is the needling of acupuncture points to affect the flow and balance of chi. Using needles to mechanically produce a temporary local counter-irritation effect is not acupuncture – even though it may be an incidental consequence of this practice and may have contributed to its perceived effectiveness.

3) Claims for efficacy are often based upon a bait-and-switch deception.

The most common example of the “bait-and-switch” for acupuncture are studies that examined the effects on pain of electrical stimulation through acupuncture needles. This is not acupuncture – it is transcutaneous electrical stimulation (TENS), which is an accepted treatment for chronic pain, masquerading as acupuncture.

This is not a quibble. Science requires unambiguous definition of terms and concepts. If acupuncture is said to be something scientifically then it must have some specific and unique characteristics. In medicine that means it should have a specific mechanism of action – and it is that mechanism that we would call acupuncture. Electrical stimulation is no more acupuncture than if I injected morphine through a hollow acupuncture needle and then claimed that any resulting pain relief was due to “acupuncture.”

Further, during a typical acupuncture treatment there are many other incidental effects that may occur. The atmosphere is often relaxing, and practitioners typically will palpate the “acupuncture points” prior to inserting the needles, for example. Practitioners also provide their kind attention, which has a positive psychological therapeutic value. There are therefore many nonspecific subjective effects that could lead to clients feeling better, making the actual insertion of needles an unnecessary component.

Reports of acupuncture anaesthesia are also misleading. Independent investigation shows that patients having surgery under anaesthesia (dramatic reports of which are largely credited with acupuncture’s popularity in the West) reveal that patients were receiving morphine in the IV fluid. Other reports indicate that patient were experiencing great pain, but were simply instructed to remain quiet by the surgeon (a product of Eastern culture). There are no verified reports of acupuncture serving as effective anesthesia during surgery.

4) Clinical trials show that acupuncture does not work

The previous points are all reasons to be highly skeptical of the claims made for acupuncture, but they are all also trumped by the ultimate consideration – the direct scientific evidence. There is a surprisingly large published literature on the clinical effects of acupuncture. Most people are equally surprised to learn that the literature is essentially negative – probably because the press cherry picks apparently positive studies and re-prints without investigation the press releases of acupuncture proponents.

It is important to evaluate the literature as a whole to see what pattern emerges. The pattern that does emerge is most consistent with a null effect – that acupuncture does not work.

Controlled clinical trials of actual acupuncture (uncontrolled trials should only be considered preliminary and are never definitive) typically have three arms: a control group with no intervention or standard treatment, a sham-acupuncture group (needles are placed but in the “wrong” locations or not deep enough), and a real acupuncture group. Most of such trials, for any intervention including pain, nausea, addiction, and others, show no difference between the sham-acupuncture group and the acupuncture group. They typically do show improved outcome in both acupuncture groups over the no-intervention group, but this is typical of all clinical trials and is clearly due to placebo-type effects. Such comparisons should be considered unblinded because patients know if they were getting acupuncture (sham or real).

The lack of any advantage of real over sham acupuncture means that it does not matter where the needles are placed. This is completely consistent with the hypothesis that any perceived benefits from acupuncture are non-specific effects from the process of getting the treatment, and not due to any alleged specific effects of acupuncture. In other words, there is no evidence that acupuncture is manipulating chi or anything else, that the meridians have any basis in reality, or that the specific process of acupuncture makes any difference.

More recent trials have attempted to improve the blinded control of such trials by using acupuncture needles that are contained in an opaque sheath. The acupuncturist depresses a plunger, and neither they nor the patient knows if the needle is actually inserted. The pressure from the sheath itself would conceal any sensation from the needle going in. So far, such studies show no difference between those who received needle insertion and those who did not – supporting the conclusion that acupuncture has no detectable specific health effect.

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study the smaller the effect, and the best controlled trials are negative. This pattern is highly predictive of a null-effect – that there is no actual effect from acupuncture.

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41 responses so far

41 Responses to “Why I Am Skeptical of Acupuncture”

  1. CKavaon 25 Aug 2008 at 10:30 am

    Great summary! This article and the chapter on Acupuncture in ‘Trick or Treatment’ are now going to be my go to pieces when debating issues with acupuncture.

  2. DevilsAdvocateon 25 Aug 2008 at 10:59 am

    It’s like the skeptical Olympics and Novella, ahem, sticks the landing.

  3. daijiyobuon 25 Aug 2008 at 11:05 am

    I guess the LAc community will be a little upset to hear that their Master’s in Science degrees are based upon, in reality, figmentations

    [e.g., vitalism=chi/qi=life force=prana=vis medicatrix naturae etc.]!!!

    There seems to be quite a bit of academic falsehood going around:

    schools posturing as science ‘that which is profoundly not science’

    {e.g. http://www.bridgeport.edu/pages/3247.asp ; of a labeled “Health Science Division” within a “Health Sciences Center}.

    I call such, these days, flim-flam — aka a ‘confidence trick’

    {e.g. http://naturocrit.blogspot.com/2008/08/university-of-bridgeports-falsehood.html }.

    -r.c.

  4. Yooon 25 Aug 2008 at 11:48 am

    A lot of the same criticisms apply to traditional Eastern medicine. While there might be some quite useful tidbits in there, the overwhelming prevalence of mystical mumbo-jumbo and many practitioners’ unwillingness to call bullshit when they see it (or for that matter, their unwillingness to even test whether something is gold or bullshit) makes me really wary of trying them out.

    And yet schools teaching the discipline are quite reputable and give out highly sought-out medical degrees around here. Not being familiar with their curriculum or academic atmosphere, I’m not sure if they actually prefer an evidence-based approach or are part of the problem.

  5. DevilsAdvocateon 25 Aug 2008 at 12:15 pm

    Science-based medicine is so tedious, so difficult, so demanding, and for all it can do, there is much it cannot. Faith or myth-based medicine is the fast and easy pathway to health! A couple well-placed needles, a dose of homeopathic water, or a Reikist waving hands about and off you go, better than ever!

    Well, OK, not for a tumor or a broken leg or diabetes, but for vague and nonspecific low level complaints, FB/MB medicine works just fine!

    Well, OK, usually only briefly, the result of placebo, and sometimes FB/MB medicine gets credit for conditions that would have abated untreated, but that leaves an awful lot for which it works great!

    Well, OK, sure, sometimes it turns out that…

  6. rc_mooreon 25 Aug 2008 at 12:30 pm

    This is anecdotal, I admit, but I know a number of professional acupuncturists, (and chiropractors) and they tell me the same story — their patients are people who claim to have been unable to find relief from mainstream medical practitioners. I believe this contributes to the myth that acupuncture and chiropractic are effective treatments — the patients are biased against mainstream medicine and biased for alternate treatments. They therefore inflate the benefits of the treatment. Acupuncture and chiropractic advertise patient testimonials as there primary evidence of the effectiveness of their methods — something I have never seen done by a mainstream medical practitioner.

    Such patients are unimpressed by blinded studies, or discussion of placebo effects. Their bias against science is what leads them to seek out alternative treatments in the first place. What I find somewhat disturbing however, is alternative treatments are now gaining growing acceptance in the mainstream medical community, even when they are not validated by clinical evidence. This is perhaps due to the revenue stream available from such uncritical patients?

  7. delaneypaon 25 Aug 2008 at 12:30 pm

    Perhaps when saying “acupuncture does not work” you should explicitly append the phrase “any better than placebo.”

    I am an FP physician, and out of curiousity have begun asking my patients if treatment X works 30% of the time, but taking a sugar pill also works 30% of the time, would you still want treatment X? An amazing number actually would want a treatment that works no better than placebo, such as acupuncture.

    Of course, many of my patients down here in the South can not be considered highly educated. Nonetheless it reflects the scientific illiteracy that pervades the American public, which does not seem to grasp the concept of a “control group”.

  8. Fifion 25 Aug 2008 at 12:43 pm

    rc – When dealing with something as incredibly subjective as chronic pain, the patient’s perception is a large part of how effective something is perceived to be (it’s all about perception, in other words). Some chronic pain patients really like dramatic procedures that involve needles and having things done to them – rituals and ritual objects – and receive a great sense of relief because something/anything has been done (whether the ineffective treatments are given by a doctor or an acupuncturist, and generally the more drama and procedure there is the more “effective” it’s perceived to be). People, in general, want something “done” even if the only real treatment is letting something run its course. There may be some other mechanism at work vis a vis acupuncture as well – though certainly the more rigorous studies are starting to indicate that this isn’t the case.

  9. revmatton 25 Aug 2008 at 2:36 pm

    I find it amusing that people in the U.S. are so eager to adopt TCM when one of the biggest issues for people in China is pressuring the government to provide better access to real medical treatment. The younger people I talked to when I was there still pay lip service to traditional superstitions, at least when older folks are around, but they didn’t take most of it that seriously. They still were all pretty committed to herbal medicine (and as we know some of those work, others don’t, etc etc). But that had more to do with lack of access to ‘western’ medicines outside the major cities than anything else.

    People in our travel group had to go to the hospital (including the ER) and we all went for a routing checkup for the kids. The ER experience was by all accounts frightening and unpleasant due to it being a poor area where they didn’t have the kind of maintenance or level of service we in the U.S. might be used to. But the doctors still didn’t try to use acupuncture to address ear infections or any such nonsense. Antibiotics were prescribed along with Tylenol and a multivitamin. Same thing our pediatrician prescribed when we got back to the U.S.

  10. Coronachon 25 Aug 2008 at 3:38 pm

    Thanks, this is a good summary and useful. There is so much bunk out there, it’s hard to keep it all straight. My interest in acupuncture was piqued recently when I encountered a ‘certified pet acupuncturist.’ I couldn’t believe it. Then I saw what she charges…

  11. [...] “Why I am Skeptical of Acupuncture”-Steven Novella [...]

  12. rc_mooreon 25 Aug 2008 at 4:52 pm

    Fifi –

    Your comment on dramatic procedures and rituals reminded me of some other studies that have been done that show mainstream surgical procedures may be no more effective than a placebo. (I googled and quickly found studies on brain and knee surgery being no more effective).

    Maybe we are being too hard on the acupuncturist — their delusions may be no greater than that on some respected surgeons.

    Just joking, I think.

  13. Millsleyon 25 Aug 2008 at 7:33 pm

    Hi,

    As a kid, I had migraines occasionally and when I got into high school they were severely debilitating; I would be missing class about two days a week. I was seen by multiple neurologists and given a slew of prescription drugs which helped with the pain but came with the side effect of completely knocking me out. Eventually a friend recommended her chiropractor, who was also a licensed “applied kinesiologist” and used what would be called acupressure. The main method to progressively lessen the pain was to lay on the table and he would muscle-test my arm or leg (I should be able to keep it in place). While holding certain pressure points, my appendage would become much weaker and he would apply pressure to corresponding points to balance the system. I would usually walk out of his office completely migraine-free.

    Now I’ve read a lot about the subject, and I agree that there is a lot of woo-woo and stretches of the imagination to account for its effectiveness. However, the most interesting account I’ve read is from The Electric Body by Dr. Robert Becker. The book is mainly about his experiments on salamanders and the study of regeneration (he was able to induce full regeneration in amphibians without the ability and partial regeneration in rats – in the 60s!). One of his major points is that although we have a very in-depth understanding of biochemical processes in the body, we don’t have a very cohesive understanding of whole-body health and regeneration – which is inextricably linked to electricity. He performed some experiments on acupuncture meridians and found that not only did acupuncture points have hundreds of thousands of ohms less resistance (at some points, millions of ohms) than surrounding skin, but also generated very faint pulses of direct current to the central nervous system.

    Although you claim electric acupuncture as a TENS masquerade, that fails to consider that perhaps both systems work through the same modality. If acupuncture points are generators along the power lines that send DC to the CNS, then TENS is traveling through these points to reach the brain anyway. Electric stimulation, a slight puncture or applied pressure (which evoke electric response) all function electrically.

    Clinical trials are tricky and often utilize design flaws to see what the designer of the experiment wants (hence the trials going both ways, and the unnaturally high positive results in China). I daresay most of the literature is actually positive, and unless you show a numerical comparison of positive to inconclusive results I really don’t think anyone should take your word on that. There’s probably a study that studied studies which could give you your figures.

    I realize you’re a die-hard skeptic but I trust my experiential evidence and have tried to understand it as best I can (without throwing logic and reason out the window ;) . I really recommend The Electric Body – I think if mainstream science had kept unraveling the threads Dr. Becker pulled we would have a much clearer understanding of human health.

  14. ammonlon 25 Aug 2008 at 8:49 pm

    My father is an acupuncturist, so I grew up learning about CAM before it was called that and before I knew any better. However, I always wondered why my problems didn’t go away after being treated by him, even though he was so confident that they would! I have met many of his patients who also have the utmost confidence in his abilities and will share anecdotes of how they’ve recovered. Even when I was young, I wondered why, if this worked so well, they were back week after week with more problems? Of course the first week it was a liver problem (as diagnosed by my father); the next a kidney problem; etc, so I guess they assumed the first problem was solved and they were experiencing a new issue.

    In hindsight, everything is a lot clearer. My father is actually a chiropractor, acupuncturist, naturopath, and homeopath, and gobbles up any kind of eastern or alternative treatment that he can find — essentially any practice that doesn’t hold itself to scientific standards of effectiveness. I’m pretty sure his confidence is one of the keys to his believed success — this affects his patients. It may actually help them to heal (conditioning effect) or even if they don’t feel better they report that they do (expectancy effect).

    In my father’s case, I think Dr. Novella hit it right on the head when he called attention to how “practitioners also provide their kind attention, which has a positive psychological therapeutic value.” My father spends a full hour with each patient, attending to many parts of their bodies using all sorts of gadgets, aromas, lighting, and so forth to affect the way his patients feel. These are people who look up to him (with the many letters after his name — D.C., L.Ac., N.D., D.Ht.) as much as I would look up to a clinical neurologist at Yale, and I believe getting this kind of personalized attention is really very therapeutic for them.

  15. dcardanion 25 Aug 2008 at 10:49 pm

    Coronach said “My interest in acupuncture was piqued recently when I encountered a ‘certified pet acupuncturist.’ I couldn’t believe it. Then I saw what she charges…”

    I lost a dog to cancer earlier this year. I had thought my vet had done everything they could for him. However, the main doctor we worked with left the practice shortly after that to start doing animal acupuncture. Now I’m left wondering if she might have caught his condition sooner if she had been more science-based. Did she assume some of his problems were due to “misaligned chi” or other crap like that? It’s really depressing because had we caught it earlier, it could have been easily removed and likely would not have spread. Unfortunately, we got to it too late and it had already spread to other parts of his body. His last couple of weeks were awful. It really depresses me to think about.

  16. Intrepydon 25 Aug 2008 at 10:49 pm

    Well done. Careful logic and compelling analogy makes for a decisive argument. I’ll send a link to some true believers. I hope you continue to keep a civil, accessible tone. Too many skeptics infuse ridicule and condescension into their arguments. I feel like that serves only to undermine the possibility that they might “show somebody the light.”

  17. [...] at Neurologica Blog, Steven Novella expressed scepticism over acupuncture. I’d like to correct a few errors that Steven had [...]

  18. Nitpickingon 26 Aug 2008 at 8:43 am

    revmatt, note that multivitamins are just as superstition-based as acupuncture, at least for people eating a normal diet.

  19. JKOon 26 Aug 2008 at 8:05 pm

    Wonderful article! I wish I could be that articulate when debating other “pre-scientific superstitions”.

  20. suszennnon 26 Aug 2008 at 10:18 pm

    What science is or should be is not completely defined. The lexicon states: “Science…, the aggregate of human knowledge for an epoch…; a collection of findings regarding an area of knowledge interrelated in a fundamental way. … Science is a methodologically designated knowledge consisting of sentences interrelated in a fundamental sense, inter-subjectively communicable and testable, that satisfies particular scientific criteria (e.g. general validity, capable of systematizing). The uncertainty of the explanation shows itself in the circularity: science must follow scientific criteria. Nevertheless this is clear, regarding an area of knowledge “scientific” means the requirement that the knowledge consist (substantially and methodologically) of testable assertions (or “sentences”). Science generates testable assertions. An assertion or system of assertions can only be considered scientific if the assertion or assertions can be denied – technically speaking – can be tested to determine whether or not they are false. The exact natural sciences are called exact because they only make assertions that can in principle be experimentally falsified in any place or time (technically: can be tested for correctness). Not all natural sciences are based or can be based exclusively on experimentation. Biology, and consequently medicine, must support themselves to a great extent on the observation of “natural” events. When the circumstantial conditions for these observations are equivalent to those of current observations, the current observations can be used as if they were experimental observations.

    Since, as a rule, conventional medicine cannot make potentially deniable assertions for the individual case, it seeks refuge in statistics. Because statistics is mathematics, it is itself scientific, but is not a natural science. (Moreover, the highest goal of the therapeutic art is betrayed because the scientific help required in the “individual case” is denied. Example: the traditional physician informs the patient regarding his or her statistical chances of survival, but this does not assist the patient in the least with knowledge on what could be done to heal.)

    Hypotheses are not tested or even testable assertions. If one can only make assertions that cannot (yet or inherently) be proven false, one speaks of hypotheses. In the jargon, a hypothesis is really an assumption, and basically, in the theory of science, it is so as well, namely, an assertion whose truth value has not been established but it serves as assumption to build theory and prediction from . When Isaac Newton presented his theory of gravitation he was asked where gravitation came from. His reply: “I will not advance any hypotheses”. He meant that it was open to anyone to test the postulates of the law of gravitation (in modern parlance, to try to disprove it), but that it was a different thing to explain gravitation. Since this had eluded him (he had been unable to formulate assertions that were possible to deny), he stated that it was up to the generations of scientists after him – which they have yet to achieve.

  21. daijiyobuon 26 Aug 2008 at 11:50 pm

    suszennn,

    is the something you are trying to say?!?!?!

    -r.c.

  22. mat alfordon 26 Aug 2008 at 11:55 pm

    suszennn – Sorry – I’m not being rude, but there seems to be a lot of words there and very little content (that I can understand, at least). You not once mention acupunture or chi and I’m not sure I follow your point. I think you are criticizing medicine for being scientifically evidence based, but without putting forwrd an alternative. Could you make your point a bit clearer for a dumb-ass like me?

  23. suszennnon 27 Aug 2008 at 12:25 pm

    i am sure you are not a dumb-ass at all…..i think my posting makes sense… so i have to use the word for you to understand
    acupuncture….there you go
    scientifically evidence based its all just an educated
    guess.

  24. Steven Novellaon 27 Aug 2008 at 12:50 pm

    suszennn – I think you misunderstand the scientific nature of medicine, partly because you are relying on a dictionary definition, not an operational definition put forward by those actually practicing science.

    Science is not just an “educated guess” you can dismiss whenever it’s convenient.

    Start here for a better definition: http://www.sciencebasedmedicine.org/?p=1

  25. Fifion 27 Aug 2008 at 1:05 pm

    Is suszenn pec? That “dumbass” comment sounds remarkably like her.

  26. CKavaon 27 Aug 2008 at 1:31 pm

    suszeen’s post is what can only be best described as a ‘garble’. It makes no reference to acupuncture and is instead one of your dime-a-dozen rambles on the limitations of science with the added bonus of being full of unnecessary verbose language.

    When asked politely to clarify what the relevance or meaning of the post is by mat alford who even apologises for being rude and admits he might be being a ‘dumb ass’ for missing the point ‘suszeen’ responds by calling him a dumb ass and points a childish rebuttal. I strongly suspect that Dr. Novella’s reply will likewise be swept aside in the same manner without a second thought for the actual content.

    Politeness should be a matter of course when replying to posts but sometimes I think it’s worth reminding people that just because it’s the internet doesn’t mean you should act like a rude and arrogant child.

    Sorry folks for the OT, but the ignorance demonstrated in the reply to mat just got to me!

  27. gregorylenton 27 Aug 2008 at 2:09 pm

    a thousand word article could have been shortened by one acupuncture session.

    something happens.

  28. suszennnon 27 Aug 2008 at 5:18 pm

    oh no….see you got triggered by my post and saw what you wanted…to see. i did not call anyone a dumb-ass…go back and read the words and you will see. i have really enjoyed this blog and listening to your podcast.

    cant believe a well educated man would jumb down my throat for something i did not say. and just my point you did not read what was there you missed something i think you may have kicked me off the blog….like i sad i enjoy it

    and yes of course…i do work in the areas that you call quackery
    all science is and yes ( a good ) educated guess

  29. mat alfordon 27 Aug 2008 at 5:44 pm

    Surely a good educated guess is better than the sort of unfiltered fuzzy thinking that allows one to believe, well, just about anything…

  30. [...] mild beneficial effect. What I know now is that acupuncture is almost certainly no more than an elaborate placebo. What I know now is that virtually every study of acupuncture claiming to show a positive [...]

  31. CKavaon 28 Aug 2008 at 11:02 am

    suszennn- I don’t agree with your position but I do have to apologise for accusing you of something that you did not do. For some reason I was certain your post said “i am NOT sure you are not a dumbass at all”. However, re-reading it the first NOT is conspicuously absent. Maybe you are correct that I simply inferred the NOT from the rest of the content.

    Whatever the reason I clearly accused you of something in the wrong. So I apologise.

  32. mat alfordon 28 Aug 2008 at 7:29 pm

    I’ve rumbled you suszennn….. or should I say the evil Professor Dr. Hans Ulrich Niemitz (mat pulls off the mask scooby-doo style) :

    http://www.newmedicine.ca/science.php

    You woulda got away with too, it if it wasn’t for us pesky kids, etc, etc

  33. [...] (by coincidence) on the heels of my recent blog entry on why I am skeptical of acupuncture, another major acupuncture study has just been published. This study looked at acupuncture for [...]

  34. Joeon 31 Aug 2008 at 12:48 pm

    @mat alford, good job!

    “A different type of testimony on German New Medicine” http://scienceblogs.com/insolence/2006/11/a_different_kind_of_testimonial.php

  35. NeuroLogica Blog » An Acupuncture Debateon 04 Sep 2008 at 11:16 am

    [...] I pre-published (with permission) my side of the debate on “Does Acupuncture Work” here at NeuroLogica. Taking the pro-acupuncture side is Bill Reddy – his profile states that he is “currently [...]

  36. [...] the population. Less than 4% of the US population have ever used homeopathy, despite all the buzz. Acupuncture is less than 7%, despite the nearly weekly press releases falsely claiming new evidence that [...]

  37. [...] However, because unlike so many other “energy healing” methods, acupuncture involved an actual physical action upon the body, namely the insertion of thin needles into the skin to specified depths, it did not seem to me entirely unreasonable that there might be some sort of physiological effect that might produce a therapeutic result. At least, that’s what I used to think until I actually started paying attention to the scientific literature on acupuncture. That’s when I started to realize that “there’s no ‘there’ there,” if you know what I mean. Horribly designed studies with either no controls or utterly inadequate controls tend to be the norm in the acupuncture “literature” (if you can call it that). Moreover, acupuncture was touted as having value for conditions and procedures for which there is no plausible (or even mildly plausible) physiological mechanism by which it could be reasonably postulated to have an effect. Arthritis, allergies, headache, back pain, gastroesophageal reflux disease (GERD), Parkinson’s disease, post-operative nausea, hot flashes in breast cancer patients caused by the anti-estrogen drugs they have to take, infertility, it doesn’t matter. Seemingly acupuncture can do it all; it’s the Swiss Army knife of CAM therapies. Moreover, the “explanations” given to explain “how acupuncture works” seemed increasingly less plausible to me. Most of these explanations involve counterirritation or the release of opioids, and I’ve had an increasingly hard time believing that, even if these mechanisms are at play, they could have anything other than nonspecific effects, with no mechanism to explain how acupuncture could possibly do all things attributed to it. One rule of medical skepticism is that you should be very skeptical of modalities that are touted to be useful for a wide variety of medical conditions that have very different pathophysiology. Indeed, a funny thing happens when rigorous placebo controls are introduced, and that’s sometimes the placebo control does better than the “true” acupuncture; i.e., the evidence for acupuncture, taken in its totality, is completely compatible with placebo effect. [...]

  38. pekka son 11 Dec 2008 at 4:36 pm

    What do you make of systematic reviews like this one:

    http://www.cochrane.org/reviews/en/ab001351.html

    “For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and “alternative” treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.”

  39. Joeon 11 Dec 2008 at 6:55 pm

    pekka s on 11 Dec 2008 at 4:36 pm

    What do you make of systematic reviews like this one: “Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.”

    Acupuncture for this condition is unsupported.

  40. [...] Steven Novella does a great job of breaking down the reasons to be skeptical of acupuncture here. [...]

  41. sfacupuncturiston 30 Mar 2009 at 7:11 pm

    I am a licensed acupuncturist and I would like to address your article. I wholeheartedly agree that the majority of acupuncture studies are poorly written and often show conflicting results. It is a huge problem that our profession in this country is attempting to address. I also think it is highly valuable to be skeptical of anything because it fosters further study and understanding. We need further understanding and study of this medicine to ensure that patients are safely and effectively taken care of, as with any other medical system.

    I have been studying body energetics for many years and I can feel and visualize the flow of qi in a patient as I perform acupuncture on them. This idea of qi is something that many in the scientific community do not accept; however, I feel it everyday. We need to stop debating whether or not it’s real and start looking at what this qi is. What is the energetic force that acupuncture, reiki, healing touch, and clairvoyance work with? Is it a manifestation of the electrical charges in the body? Will it end up being explained via quantum physics? Will its understanding lead us to an incredible new medical discovery?

    Another point I would like to address is the training process that I went through to receive my Masters degree. One of my appreciations is for how much emphasis was placed on safety. We were repeatedly educated on herbal and pharmaceutical interactions, red flags and protocols for patient referral, as well as actual technique safety. One of my disappointments was in the lack of focus on research and efficacy compared to learning the material found on the certification and licensing exams. I believe this is a huge problem in all the major TCM schools as their pass rates on these exams increases their prestige.

    Many people turn to alternative medicine to give them relief, answers, comfort and effective care. My profession needs to embrace scientific scrutiny in order to make sure our patients are receiving the best care available.

    I want to do more than see and feel that acupuncture works, I want to be able to effectively communicate why it does.

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