October 1998
by Robert Drysdale

Dr. Novella’s comprehensive articles on alternative medicine have led me to a question: since alternative medicine lacks, for the most part, any scientific justification for its use, what then, aside from the given that many Americans are science illiterates to an alarming degree, accounts for its increasing popularity?… according to the latest Discover magazine, “Doctors and licensed practitioners administer between 9 and 12 million acupuncture treatments each year in this country, most commonly for pain control and addictions to nicotine, heroin, and cocaine.” Lewis Vaughn, executive editor of The Scientific review of Alternative Medicine and Free Inquiry, states it thusly: “Romance is in the air. The media, the public, the gurus, and the hucksters have gazed upon acupuncture, homeopathy, chelation therapy, herbal concoctions, magnetic therapy, and any other treatments called “alternative medicine”. . . and have fallen in love. So, as in any romance, current talk about a beloved “alternative” therapy is usually marked by uncritical acceptance, blind commitment, feverish thinking, and occasional cooing.” In the same article he further states that scientists have… “discovered, among other things, that acupuncture is no better than placebo, homeopathy doesn’t work, and chelation therapy can kill you.” Certainly, television exacerbates the problem and adds to the ignorance by producing shows that lack any skeptical overview of mystical claims. Bill Moyer’s embarrassingly credulous public television series, “Healing and the Mind,” featuring Chinese Qigong masters, was a blatant case in point.

An article in the New York Times “Science Times” section on Tuesday, April 28, 1998 attempts to answer the popularity question. Authored by Jane E. Brody, the article contains some interesting information concerning alternative medicine. In a nationwide random survey of 1,500 people, conducted by a marketing research firm for Landmark Healthcare Inc, it was found that 42% of households have used alternative care in the past year, with 17% having used herbal therapy, 16% chiropractic, and 2% acupuncture. The article further states: “According to a 1993 study by the Kaiser-Permanente health care system, 56% of those who seek alternative care suffer chronic pain and 22% cite stress or a mental health problem as their chief complaint. Among the most common problems are back pain, anxiety, allergies, arthritis, depression and insomnia. Evidence is mounting that alternative techniques like acupuncture, hypnosis and some herbal remedies can help relieve such conditions.”

And from an article in the Los Angeles Times August 30: “Once a countercultural phenomenon, alternative medicine is now an $18 billion industry edging into the mainstream with California leading the rest of the nation. Although it is gaining fast in popularity, alternative medicine is still very much an experiment – one that huge numbers of Americans are conducting with themselves as the guinea pigs.”

Dr. David Spiegel, a professor of psychiatry and behavioral science at Stanford University, speaking about patients who sought out alternative care, suggested they were seeking “caring attention, something they are getting less and less from physicians under managed care.” He pointed out that alternative care providers spend more time per patient by a factor of four than physicians now do. He also said “Even if an alternative remedy is just a placebo, if patients get better and there are no side effects, what’s the harm in trying it?”

But, of course, there can be harm. Debbie Benson was a nurse in Portland, Ore, diagnosed with breast cancer at 54. She had the tumor surgically removed, but because of her disenchantment with standard medicine she declined chemotherapy and radiation therapy. Instead, she turned to other healers, including naturopaths, licensed in Oregon and 12 other states as primary caregivers. Among other things, she received from one such practitioner, a mysterious salve purported to draw the cancer out of her body. Although generally, according to the American Cancer Society, a woman with breast cancer has an 86% chance of surviving five years if she receives standard medical care, Debbie died a little over a year after her diagnosis, succumbing to cancer of her lymph nodes, liver and lungs. Her brother said afterwards, “I guess she lowered her chances (of survival) by not having conventional treatment.”

Critics suggest that physical harm is not the only risk of relying on alternative medicine. Dr. John Remer, head of the Consumer Health Information Research Institute, a frequent critic of unproven therapies, states “It’s dangerous for the public to have false health beliefs. Even if (a treatment) is harmless, it gets people involved in illogical thinking. It can mess up their ability to think logically later on.” Sometimes, it seems, logical thinking has become, all too often, an oxymoron.

Concerning acupuncture, from NYASK, Fall 1997, DDS Marvin J. Schissel’s book “The Whole Tooth,” St. Martin’s Press, NY, 3/97 “Some dentists, calling themselves ‘holistic,’ have incorporated acupuncture into their practice to facilitate the flow of ‘Qi’ for their patients (and facilitate the flow of money for themselves).” The article goes on to say that none of our most sensitive instruments have thus far been able to measure this Qi energy (pronounced Chee, roughly translated as “divine breath”). An experiment is described wherein a rabbit is hooked up to an apparatus which measured endorphin levels. Upon the placing of an acupuncture needle in the rabbit a small endorphin increase was noted. A noted skeptic, who had been invited to observe, suggested pinching the rabbit on the rump. Impulsively, he did so, and a large endorphin increase was immediately registered. Conclusion: “The experiment showed that acupuncture was almost as effective as a pinch in the ass.” The article further states that any scientific evidence for the efficacy of acupuncture is, at best, equivocal. “Dr. William Jarvis of the National Council Against Health Fraud has pointed out that there is an inverse relationship between the evidence for acupuncture and the quality of the research, with best results coming from the sloppiest studies, and no results from the double blind studies. This, of course, comports with Dr. Novella’s conclusions.

A slight imprimatur of acupuncture is given in an article from the Skeptical Inquirer, July and August 1996, discussing a 1995 CSICOP delegation to China to study Traditional Chinese Medicine: “most experts today concede that acupuncture does have some analgesic properties (though its potency has been greatly exaggerated).”

Now the latest Discover magazine (September, 1998) has attempted to shed light on the controversy over acupuncture. The article, by freelance writer Catherine Dold, is entitled “Needles & Nerves,” and concerns the work of Zang-Hee Cho, Korean physicist and professor at the University of California at Irvine. Ms. Dold is quoted thus on the Contributors page: “I’ve never tried acupuncture before, but I’ve always had an open mind about it. I believed that it worked when I heard people were using it on dogs. You know a dog doesn’t experience a placebo effect.” About this, the Skeptical Enquirer states that this “ignores the fact that the immobilization necessary to insert the needles in subjects has been shown to produce a sort of catatonia/analgesia by itself.”

The article is subtitled “For those reluctant to accept that acupuncture has a real effect on the body, a physicist offers some surprising high-tech evidence.” Mr. Cho says he was motivated to do the study by an experience he had after suffering a fall in Korea. Arriving home in California 12 hours later, he was suffering a rather severe pain in his back. Relatives suggested he try acupuncture. Though he initially scoffed at the idea – as an educated person, he says, he didn’t believe in acupuncture – he tried it. And much to his surprise, it worked. After about ten minutes, he said, he felt the pain melting away.

Cho decided to explore acupoints that are traditionally used to treat vision problems, points he designated as VA1, VA2, VA3, and VA8, all located on the outside of the foot. As to his experiment, he strapped student volunteers into a functional magnetic resonance imaging machine, (fMRI), which measures minute changes in the amount of oxygen carried in the blood. This is, according to the article, “presumably a rough measure of glucose uptake by various tissues and thus a good indicator of which tissues are active.” The results can then be viewed on the machine as colorful brain activation maps.

Cho first stimulated the volunteers’ eyes by flashing a light in front of them. As expected, there was an increase in activity in the visual cortex as shown by a concentration of color. He then had an acupuncturist stimulate acupoint VA1 in each of the volunteers. In each, the same region of the brain – the visual cortex lit up, nearly as strongly as that caused by the light. To eliminate the placebo effect, he then stimulated a nonacupoint in the big toe. This produced no response in the visual cortex. He repeated the procedure over time – flashing light, acupoint – with each designated acupoint. All except VA2 elicited the same response. As he graphed the results, Cho noticed that there had been two distinct reactions among the dozen volunteers during the acupuncture phase, with some showing increased and some decreased activity, that is, some with more oxygen consumption and some less. This the acupuncturist explained as yin and yang. When asked which of the subjects were which, according to Cho, the practitioner, without seeing the data, correctly pointed out, in 11 of the 12, which were yin and which were yang. (Yin: lack of Qi, pale, slow pulse, depression; Yang: excess of Qi, red face, fever, fast pulse, agitation.) As to the future, Cho hopes to continue to explore, using available imaging systems, the connections between acupoints and the brain. These studies, he says, are “opening a new door for neuroscience.”

Bruce Pomeranz, neuroscientist at the University of Toronto, finds Cho’s study interesting, but “that there is a special connection between your toe and your visual system is really bizarre. That’s really mind-boggling.” He adds, however, that “the endorphin story was a big surprise; now it’s ho-hum.”

Not all are impressed with Cho’s work. Wallace Sampson, former chief of medical oncology at Santa Clare Valley Medical Center and a member of the board of directors of the National Council Against Health Fraud, suggests Cho’s paper proves nothing, contending that the study was too small and poorly controlled to be meaningful. “It’s simply a case of pseudo-science.”

Like all skeptics, I have an open mind. May the research continue.

References

1) Discover, September 1998
2) Skeptical Inquirer, July/August 1996
3) New York Times Health Section, April 28, 1998
4) New York Area Skeptic, Fall 1997
5) Los Angeles Times, August 30, 31, 1998
6) Free Inquiry, Summer 1998

Editor’s Note:
I had intended to report on the acupuncture article in Discover magazine, but the article submitted by Mr. Drysdale did an excellent job of covering this topic. I would, however, like to add a few points to those made by Mr. Drysdale.

First, it must be realized that critical analysis of published research is an essential component of scientific progress. Pseudoscientists, however, are typically resistant to such critical analysis, and often characterize such criticism as a means for skeptics to disregard their groundbreaking work because it makes them “intellectually uncomfortable.”

That said, there is much to be critical about regarding Dr. Cho’s research. One important criticism stems from other research with functional MRI. As stated, functional MRI (fMRI) is a way to image brain activity, and the part of the brain which becomes active during a specific task will “light up” when imaged with fMRI. It was soon discovered, however, that if the subject just thinks of an image recently viewed, the identical pattern of visual cortex will light up, and with the same intensity. Functional MRI is therefore a powerful but tricky tool for looking at brain function. Dr. Cho’s study was too small to account for such variables as what the subjects were thinking at the time the fMRI image was taken.

Also, Dr. Cho reported that some subjects has increased activity while others had decreased activity. It is actually much more simple to conclude that the subjects had variability in the activity of their visual cortex during the various acupoint stimulation, with no trend towards increase or decrease. There were too few subjects to see if there was a true bimodal distribution (two peaks of activity, one increased, one decreased) rather than just variability around a mean with the net effect being neutral. In any random distribution one can always take the right half of a distribution and conclude that these subjects showed an “increase” and then take the left half and conclude that these half showed a “decrease” in what is being measured.

Dr. Cho also reported that a Qi master was able to ascertain which subjects showed increased activity and which had decreased. No mention is made, however, of how the Qi master was blinded to the actual results. Dr. Cho would certainly not be the first physicist to be fooled during such an experiment.
I must therefore agree with the emerging scientific consensus that Dr. Cho’s results involve too few subjects and are too poorly controlled to draw any firm conclusions. It will require better and larger studies, and independent replication, before the course of knowledge in neuroscience will be altered one bit by Dr. Cho’s research.

Filed under: Science and Medicine, Acupuncture