Dec 10 2007

Acupuncture and Misdirection

Yet another study has been published allegedly showing that “acupuncture works.” The study is published in the journal Anesthesiology and looks at post operative nausea and vomiting. There are many problems, however, with the conclusions drawn from the study an it does not support the claims of acupuncture.

The study also represents a big problem with the complementary and alternative medicine (CAM) literature and movement – that it uses ultimately fictional categories of types of treatment and then blurs those lines in an attempt to promote the category. In fact the entire category of CAM itself is a political fiction (there are no underlying principles that define CAM as a category) and CAM proponents deliberately try to include within the CAM category things like nutrition and physical therapy (which are evidence-based and definitely not CAM) as a way of legitimizing the category. Typically proponents will extrapolate wildly from – nutritional therapy A works for disease B, therefore nutrition works, and therefore CAM works, since nutrition is part of CAM.

Claims for acupuncture often follow a similar model – beginning with a treatment that is not really acupuncture and then concluding that because this treatment works, all of acupuncture is vindicated. This is sloppy thinking, and good medical scientists have learned long ago to be very precise and careful in drawing conclusions from the evidence, and to not go beyond the evidence.

So let’s see where this study fits into acupuncture and the acupuncture literature. Acupuncture is based upon the traditional Chinese medicine (TCM) philosophy of chi, or the life energy. According to TCM chi flows through the body through meridians, and there these meridians cross there are points where the flow of chi can be blocked or inhibited. Acupuncture is based upon sticking needles at acupuncture points – where meridians of chi cross – to free up blocked chi.

First, if we look at the entire acupuncture literature it clearly shows that any apparent effectiveness of sticking needles in the skin is completely independent of where those needles are stuck, how deep they are stuck, and whether or not they are manipulated. In other words, there is no evidence for meridians, chi, or acupuncture points.

There may be a non-specific and short-lived physiological response to needle sticks – although any clinical benefit of this appears to be brief and minimal (if it exists at all). But (here’s the big question) can we or should we refer to the sticking of needles into the skin at non-acupuncture points and without the usual depth and manipulation that is supposed to affect chi, acupuncture? By any reasonable definition this is not acupuncture, and calling it acupuncture is a source of deception and confusion.

The current study employs electrical stimulation – which is also not acupuncture but is masquerading as such. Electrical stimulation of nerves has known physiological effects and are proven and used for various indications. Trancutaneous electrical nerve stimulators (TENS) units are used for chronic pain. Vagal nerve stimulators are used to treat seizures. Nerves are electrical organs, they conduct electricity for physiological effect.

What this study is actually comparing is the difference between electrically stimulating the ulnar nerve vs stimulating the median nerve intraoperatively and its effect on nausea and vomiting. It is not testing acupuncture. The notion that because the median nerve stimulation point is also the “P6” acupuncture point is an irrelevant pseudoscientific distraction. The fact that the acupuncture literature essentially proves that acupuncture points are meaningless (to say nothing of all of biology, physiology, anatomy, neurology, etc.) further argues that such a designation is not warranted. Studies involving electrical stimulation at alleged acupuncture points do not actually test any of the precepts of acupuncture – but they do contaminate the literature and generate confusion, which is then exploited by acupuncture proponents to promote conclusions not justified by this research.

I will also note that the authors did not fairly represent the literature in their discussion and conclusions. They did not mention a recent study, for example, that compared acupuncture to no acupuncture and is the first study of which I am aware that actually blinded the no acupuncture group by employing sheathed needles (in the control group the needles did not penetrate the skin). The study was looking at cancer patient getting radiation therapy, and showed no difference at all between the acupuncture and placebo group.

Also, it is interesting that some studies that purport to show an effect from acupuncture showed a decrease in nausea but not vomiting (which is true of the current study) or of vomiting but not nausea. This makes the results seem more like noise that a true effect, and if a true effect it would be more likely that the pattern would be similar across studies. Typically in medicine when we see this pattern (different outcome measures are improved in different studies) the results are considered less compelling and more likely to be random chance than a real effect.

Therefore, I do not find this one study compelling. The acupuncture and nausea literature is generally negative and inconsistent. The acupuncture literature in general tends to be negative and is solidly negative with regard to the reality of chi, meridians, and acupuncture points.

The literature is also contaminated by many studies, like this one, that are not actually looking at acupuncture but at other things, such as electrical nerve stimulation. The net effect of such studies is not to improve the practice of medicine or increase our knowledge of biology or medical treatments, but as a source of misdirection in order to promote demonstrably false and unscientific beliefs to the public.

14 responses so far

14 thoughts on “Acupuncture and Misdirection”

  1. Scepticon says:

    In regards to mis-representing acupuncture, I recently saw a sign outside of an acupuncturists that promoted needleless acupuncture. I looked this up to find that it is apparently magnet therapy.

    I know that there is often overlap in medicine but this seems to me to be just trying to fit as much bunk as possible under the recognised name of acupuncture.

  2. delaneypa says:

    During my brief career in medical research, it became quite clear that most medical literature is junk (or regurgitation of other research). Most is written by people required to publish in order to get a degree, complete a fellowship, or keep their faculty position. Interest in the topic at hand ma or may not be present.

  3. superdave says:

    It’s always fatigue, or pain, or nausea…what do those things have in common?

  4. ellazimm says:

    Delaneypa: are you thereby suggesting that most medical research is also worthless?

  5. Nevar says:

    I’m not sure what delaneypa is implying. Recently I came across this, which appears similar to his/her perspective, but also just does not seem like an accurate assessment to me.:

    “Actually scientists can be terribly lazy sometimes. Most of the technological advances we see around us are really technical advances.

    Medicine is a particular bugbear because most of the life-span improvements acrue from 1- better hygiene and 2- lower infant mortality (largely because of better hygiene).

    Anti-biotics are useful, but most catastrophic diseases treatable in this way are hardly a threat any more. Even then anti-biotics are starting to near the end of there useful life because of resistance and the same is true of anti-malarial drugs. As for for doctors, don’t get me started. You are more likely to get qualified medical advice from your plumber. Good salesmen though (lot’s of money for Pfizer).

    It statistically fairly likely that no major pharmaceutical products on the market today actually do much more for you as an individual than placebo, and then we haven’t spoken about side effects.”

  6. DLC says:

    poking someone with a needle to cure physical ailments ?
    I’ll file it next to giving someone water to cure their ailments.

  7. daedalus2u says:

    Fatigue, pain and nausea are all (in large part) mediated by nitric oxide signaling, and so are particularly susceptible to the placebo effect (which I discuss in my blog as being due to generation of nitric oxide by the body in response to particular types of experiences and beliefs).

  8. Aaron S says:

    Good post!

    Note: “more like noise that a true” should be “than a true”.

  9. psamathos says:

    It seems unusually common to have a reported conclusion–especially in the abstract–be completely different from the actual results of an alt-med study. Makes me wonder how this stuff gets published. For example, I looked at an acupuncture study that employed neuroimaging where completely ignored the fact that patients reported “no difference between pre- and post-treatment pain in any of the three conditions,” which were real acupuncture, sham acupuncture, and an overt placebo. Yet in spite of this, the study’s conclusion was positive and reported that real acupuncture has a “specific effect” over the other two while completely ignoring the fact that it has no effect on pain. It really is amazing how easily you can twist the facts to fit your bias. All the more reason to read critically.

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