This week is Acupuncture Awareness Week. This is probably a good thing as, of all the alternative medicines, acupuncture carries perhaps the most myths. These myths need to be addressed.
Acupuncture has achieved an accepted status perhaps even more than chiropractic and osteopathy as being now an accepted part of mainstream medicine. Why is this? Let’s look at some of these myths.
1. Acupuncture is Thousands of Years Old.
This is not true in any meaningful way. The proponents of acupuncture claim that ancient texts describe acupuncture. What they describe, if they do mention something like acupuncture, is indistinguishable from other cultures’ pre-scientific surgery, including lancing and blood-letting using blades, thorns and so on. Just as homeopathy is a ‘placeboised’ form of proto-pharmacology where the amount of active substance has been reduced to zero, we can think of acupuncture as a placeboised form of primitive surgery where the intervention has literally been reduced to a pin prick.
2. Acupuncture theory and techniques have been developed over hundreds of years.
The first western reports of Chinese Medicine in the 14th Century made no mention of acupuncture. Even by the 17th Century, acupuncture carried none of the ‘chi’ baggage and was a very much simpler system. Modern acupuncture, as you will see it on the High Street is an invention of the latter half of the 20th Century. In particular, it was developed, propagandised and exported as part of the Cultural Revolution in China. Nixon’s visit to China in the 1970’s result in a huge interest and development in Western Countries. Some aspects of acupuncture, such as ear or auricular acupuncture are entirely an invention of the West, having been invented in France in the 1950’s and exported back to China to be incorporated back into so-called ‘Traditional Chinese Medicine’. Acupuncture as you see it today has been created within living memory. It’s just that those who created it want you to think that it is ancient.
3. Science is catching up with Acupuncture and showing how it works.
Proponents of acupuncture make claims that needling affects a ‘life force’ that flows through channels in the body – the meridians. Specific needle points can adjust the flow and affect the course of illness. This is pure gibberish, and there is not a shred of good evidence that this is true. Indeed, modern anatomical knowledge contradicts these claims. Sometimes however, acupuncture is dressed in the garb of scientific knowledge. For example, some claim that studies have shown that needling releases endorphins which can inhibit pain signals. Punching people in the face also releases endorphins and can distract from some other pain in the body. People do not create therapeutic modalities around face punching because of this though.
4. There is plenty of published evidence to support acupuncture.
Indeed, there are thousands of published studies into acupuncture. However, recent reviews of the published literature show many weaknesses in this body of evidence. The vast majority of these studies are flawed in that they do not have proper controls to compare acupuncture to. The research is extensively used for advertising purposes but bears no critical scrutiny. Huge numbers of studies have been performed in China but all of them are positive. This makes it impossible to trust this literature base. In the past decade, research techniques have enabled proper controls. Acupuncture is compared to sham acupuncture by either sticking the needles in the ‘wrong’ place or by using special retractable needles that do not penetrate the skin properly but feel like acupuncture. In both cases, patients are ‘blind’ to whether they are receiving real or sham acupuncture. The results of such studies show that there is no consistent difference between real and fake acupuncture. That really ought to be it for this technique.
5. Thousands of people routinely report positive effects from acupuncture
Indeed. But this does not mean that acupuncture provided specific effects that caused the improvements. The postman always goes away after my dog barks. But she does not go away because my dog is barking. The postman is going to leave anyway. Similarly, people report improvements in various conditions after acupuncture. But this does not mean acupuncture helped. In many self-limiting conditions treated by acupuncture, the condition was going to get better anyway. Sports injuries and back pain are good examples of conditions that are self-limiting and improve over time by themselves.
It is possible that some people do experience a placebo effect from acupuncture. Placebo effects are where expectations and beliefs are directly manipulated by the treatment. Pain is a subjective symptom that can be influenced by personal expectations. Placebo effects are typically short-lived and unpredictable but do happen. The natural course of illnesses and the possibility of placebo manipulated expectations can explain people’s experiences of acupuncture.
6. Acupuncture is completely safe
There are a number of potential risks from acupuncture, both direct and indirect, but you will not find acupuncturists discussing them objectively. The intervention of sticking needles into you carries an obvious infection risk. Pushing in deeper into the body might interfere with vital functions, the most serious can involve puncturing the lungs or heart or causing internal bleeding. These problems are rare but completely avoidable. What is clear is that there is significant under-reporting of problems so that we have no good idea of how frequent they are.
7. Hasn’t it been used instead of anaesthetics in China?
Part of the myths that sprang from Nixon’s visit to China in 1971 was that a journalist had an appendectomy whilst under anaesthesia from acupuncture. This appeared miraculous and helped spread the idea that needling was some sort wonder treatment from the East. Unfortunately, the accounts were rubbish. Despite this, the myths persist. Ten years ago, the BBC broadcast a programme that implied a woman on film underwent heart surgery using acupuncture as an anaesthetic. Simon Singh complained to the BBC and after a battle they had to admit the woman had been pumped full of a cocktail of sedatives and anaesthetics so she did not feel the operation. The acupuncture she had during the operation was cosmetic.
8. Acupuncture is a regulated profession.
Anyone in the UK can call themselves an acupuncturist. Whilst courses exist, there is no meaningful oversight to ensure you will be treated by someone who takes into account the best evidence and is fully appraised of the risks and communicates that to you. Indeed this is actually unlikely as courses teach students many of the myths discussed above.
The British Acupuncture Council is the largest of the ‘self-regulators’ in the UK and has (shamefully) been given a stamp of approval for its regulatory ability by the Professional Standards Authority. The PSA does not care if the treatment is effective or not, only that the body ticks the right boxes in a procedure if someone makes a complaint. As you can see from their website, the British Acupuncture Council concerns itself primarily with promoting acupuncture. This is in direct conflict with a regulators’ obligation to primarily protect the public. Do not expect any meaningful oversight or protection.
9. But if acupuncture works by the placebo effect, isn’t that good enough?
All treatments have the capacity for a placebo effect. That is, their specific benefits can be enhanced by the non-specific benefits of a placebo. It is surely better to undergo a treatment that has real effects than one that has no specific effects such as acupuncture. Acupuncture may be theatrical and be a good placebo, but placebo effects tend to be transitory and unpredictable. They should not be relied upon to give relief. Importantly, placebo effects do not affect the course of an illness, only its perception. Hence, placebo may be desirable in pain relief but could be catastrophic if used for an illness that could harm or kill such as asthma. Furthermore, patients are routinely misled that acupuncture can affect underlying conditions such as fertility issues. Patients are being misled and ripped off by practitioners.
In order to give a placebo effect for an inert treatment like acupuncture, the practitioner must either be systematically incompetent or lie to you. They must either incorrectly believe acupuncture is real or try to make you believe it is. Neither is desirable. An incompetent acupuncturist, whose beliefs that needling can have specific effects, may well delay you seeking genuine treatment resulting in prolonged suffering or even death.
10. There are more things in heaven and earth, Science Boy, than are dreamt of in your philosophy.
Indeed, but I hope I have shown here that acupuncture is not one of them.
The following Google Ngrams, or book word-counts, are interesting. There are difficulties in interpreting Ngrams, but it is interesting to see the huge spike in publication about acupuncture after the 1970’s. A similar Ngra m is shown for simplified Chinese showing spikes both in Chinese language publication and English. We cannot expect pre 1950’s data for simiplifed Chinese, but what is clear is the Maoist spike that coincided with his barefoot doctor campaigns and subsequent propaganda to the West.
Ngrams of ‘acupuncture, homoeopathy, chiropractic’
Ngram of ‘acupuncture’ 针刺 (Simplified Chinese)
I’m against this unproven nonsense and against using placebos, but isn’t it true that placebos work even when one is aware it is bs? (Just for the sake of accuracy).
Good to know “placebo effect” lasts about 45.6 days. This is about the same as clinical hypnosis suggestions.
So discussion should be how long has your or the result lasted.
IFone does the extensive research on a person’s satisfactory results many have gone much longer than the 45.6 days! It will be over a year or more.
Utilizing the placebo effect against any form of treatment is shallow at best.
Stephen, I think you may be thinking of the work of Ted Kaptchuk. And my short summary is,no, not really
A big unaddressed problem of this is the Hawthorne Effect, whereby participants in trials tend to perform in a way that pleases the researchers because they are in a trial. It’s very hard to know what would happen if participants were blinded yo the fact that they were participating!
And finally, statistically significant effects (if any positive results survive the aforementioned criticism) are not the same as clinically significant effects and with SCAM therapies even the most rose-tinted reports struggle to claim clinical significance.
I suffered from chronic and debilitating pain for 3 years after irreversible trauma, and had been through the orthodox medical mill. In desperation, and without much hope, I tried a version of acupuncture. After a single treatment the pain I had lived with for so long disappeared. As a trained clinical scientist I am very familiar with the placebo (and Hawthorne) effects, and for many weeks expected the pain to return. It never did, and that is more than 15 years ago now; even though the original tissue damage remains.
This is, of course, purely anecdotal and therefore of little value to you, or indeed to science; but it was the most valuable clinical intervention I ever experienced.
This is not that awesome. I have a stone that repels elephants! I have it with me while I write this letters… and you know what? There’s no elephants near!
CONfirmation bias !!!!
How wonderful that the stone was finally able to cure your previous three-year chronic and debilitating infliction of elephants after nothing else worked.
Big Pharma’s hugely profitable deadly psych meds are proven to be NO MORE EFFECTIVE THAN PLACEBO. This does not stop their sale. Nor do countless mass murders or suicides caused by them, stop the profit.
I am a science teacher from a science family. I am also a licensed, board certified acupuncturist in the very highly regulated state of Illinois, home to the AMA. Science and acupuncture are not mutually exclusive.
Susan Grumbine said:
In what way?
In China and I have been there many women deliver in a Chinese hospital pain free utilizing ONLY acupuncture.They ‘talk and even joke’ with the doctors during the delivery process.They patients and MD/s will tell you they heal faster too.
Brave anonymous. Do you read the studies you post?
“However, due to lack of large multicenter randomized controlled clinical trials, standardized evaluations of clinical effects in clinical researches and detailed mechanism study in preclinical researches and unequivocal conclusions about the effectiveness, efficacy, and mechanisms of acupuncture in this field cannot be obtained from those researches yet. Further clinical and preclinical studies about the use of acupuncture in delivery with improved methodology is still needed.”
My wife had carpal tunnel syndrome so bad I had to zip her zippers and button her buttons. Three sessions of acupuncture cured that for about 20 years and counting now.
Acupuncture is not thousands of years old for the simple reason that only in the last what 50 years? Have they been able to make needles as fine as acupuncture needles. The “thousand year old” acupuncture needles are closer to knitting needles.
Some time ago I posted a comment about the fact that the simplified Chinese characters for “acupuncture” could not have appeared before 1950 because simplified characters were not put into practice until the 1950s. I see that my comment has been deleted — probably because I said that this was an example of the sloppy research and reasoning often used by this and other skepticist sites (even though I agree with their conclusion here and on most other issues). I see now that the fact about no simplified characters before the ’50s has instead been incorporated into the caption on the Ngram. OK, good, thanks. But the research is still sloppy, and therefore unconvincing. You should have done a search on both the simplified *and* the traditional characters in order to see what the *true* history of mentions of acupuncture is. Also, in good scientific practice, you should have considered what other explanations there might be for the Ngrams, and then tried to show that they are in fact not the reason.
Dudley – I am not aware of any such comment having been submitted let alone deleted. The only reasons for me deleting comments are around comments that advertise, are abusive or are in some other way not in the spirit of good debate. And as far as I remember, my note about simplified characters has been there from the time I published. The reason traditional characters are not included is because google ngrams does not support it. I acknowledge the limitations of such an approach. But I would also say that even if it was included there would be problems with interpretation. What the ngrams do very clearly show is the rise of acupuncture along with the rise of Western ‘new age’ thought with a corresponding spike in English publications. This is consistent with the hypothesis that acupuncture as we know it and see it today is very much a product of the early latter half of the 20th Century.
Dudley – I have checked and I can find no such comment in my deleted folder, my spam folder or my pending folder.
Apparently it was some internet glitch, then, and my comment never came across. I apologize for thinking that it was a deliberate deletion.
Many ancient Chinese texts including The Yellow Emperors Classic of Internal Medicine describe acupuncture in detail
This is bullshit. It describes primitive surgical techniques that have retrospectively described and co-opted as acupuncture. It describes Flint blades, knives and other instruments for blood letting and proto surgery. Not what you know as acupuncture by any stretch.
Gold and silver needles had been used to perform acupuncture in ancients days pre BC also the Ling Shu chapter 78 in an essay of the nine needles describes two types as having similarity to needles used to work cloth.As any tailor would verify fine silk embroidery could not have been performed using crude tools. The imperial court physicians would not have dared to use any crude apparatus. An honest appraisal of the classics will reveal how sophisticated the level of acupuncture was in ancient times
Fortunately, we can read. This describes nothing like modern acupuncture.
I hope you don’t believe this shit?
Nice write up. An old friend went into this and I always thought it was pseudo science but wanted to do my due diligence. Between your writing and the comments I don’t think I need to do any more poking around the net to form an informed opinion.
I want to try acupuncture method it is safe if you have a kidney problem and lupus
How do you know it’s safe? Or effective?