MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Several months ago, my co-workers and I once again re-visited the contentious issue of acupuncture’s safety. We published several articles on the topic none of which, I am afraid to say, was much appreciated by the slightly myopic world of acupuncture. The paper which created overt outrage and prompted an unprecedented amount of hate-mail was the one on deaths after acupuncture. This publication reported that around 90 fatalities associated with acupuncture had been documented in the medical literature.

The responses from acupuncturists ranged from disbelief to overt hostility. Acupuncturists the world over seemed to agree that there was something profoundly wrong with me personally and with my research; they all knew that acupuncture was entirely safe and that I was maliciously incorrect and merely out to destroy their livelihood.

So, am I alarmist or am I just doing my duty in reporting important facts? Two new articles might go some way towards answering this intriguing question.

The first is a review by Chinese acupuncturists who summarised all the adverse events published in the Chinese literature, a task which my article may have done only partially. The authors found 1038 cases of serious adverse events, including 35 fatalities. The most frequent non-fatal adverse events were syncope (468 cases), pneumothorax (307 cases), and subarachnoid hemorrhage (64 cases). To put this into context, we ought to know that the Chinese literature is hopelessly biased in favour of acupuncture. Thus the level of under-reporting can be assumed to be even larger than in English language publications.

The second new article is by a Swedish surgeon who aimed at systematically reviewing the literature specifically on vascular injuries caused by acupuncture. His literature searches found 31 such cases; the majority of these patients developed symptoms in direct connection with the acupuncture treatment. Three patients died, two from pericardial tamponade and one from an aortoduodenal fistula. There were 7 more tamponades, 8 pseudoaneurysms, two with ischemia, two with venous thrombosis, one with compartment syndrome and 7 with bleeding (5 in the central nervous system). The two patients with ischemia suffered lasting sequeleae.

The answer to the question asked above seems thus simple: the Chinese authors, the Swedish surgeon (none of whom I know personally or have collaborated with) and I are entirely correct and merely report the truth. And the truth is that acupuncture can cause severe complications through any of the following mechanisms:

1) puncturing the lungs resulting in a pneumothorax,

2) puncturing the heart causing a cardiac tamponade,

3) puncturing blood vessels causing haemorrhage,

4) injuring other vital structures in the body,

5) introducing bacteria or viruses resulting in infections.

Any of these complications can be severe and might, in dramatic cases, even lead to the death of the patient.

But we have to have the right perspective! These are extremely rare events! Most other treatments used in medicine are much much more risky! To keep banging on about such exotic events is not helpful! I can hear the acupuncture world shout in unison.

True, these are almost certainly rare events – but we have no good idea how rare they are. There is no adverse event reporting scheme in acupuncture, and the published cases are surely only the tip of the ice-berg. True, most other medical treatments carry much greater risks! And true, we need to have the right perspective in all of this!

So let’s put this in a reasonable perspective: with most other treatments, we know how effective they are. We can thus estimate whether the risks outweigh the benefit, and if we find that they do, we should (and usually do) stop using them. I am not at all sure that we can perform similar assessments in the case of acupuncture.

87 Responses to How many fatalities has acupuncture caused? And are acupuncturists in denial?

  • I’m an Acupuncturist and but I’m also a rationalist, given your reputation you may find that a little contradictory.
    I think it is good that research is being done and it isn’t a surprise to me that in millions of Acupuncture treatments there have been some adverse reactions because practitioners have been either incompetent, poorly trained or for other reasons. If you penetrate the body with a needle and you don’t know where you are going then of course you could penetrate something dangerous; a substantial part of my 4 yr training was about understanding deeper anatomy, for these safety and other reasons.
    Have you done research comparing professionally trained Acupuncturists such as members of the British Acupuncture Council to others? Or west to east etc. I imagine there is a very large gulf between practitioners with differing levels of training..
    Is it not a bit faulty to assign the conclusion to Acupuncture rather than Acupuncturists? It seems a similar thing to saying that deaths from e.g. triple bypass are all about the procedure, rather than the skill of the surgeon.

    I do feel it is innaccurate to brand ‘the world of Acupuncture’, ‘myopic’ because you receive some adverse reactions. As with all fields you get those who are open and those who are not and that is not more or less so in Acupuncture. I know plenty of passionate Acupuncturists who are lovers of science and seek to find ways it which the scientific method can be appropriately applied to Acupuncture.
    You get the same kind of response from some (e.g.) doctors, lawyers, bankers or football fans when you criticise their passion or profession, within science you get exactly the same kind of reactionary zeal, science is famed for massive and personal conflicts, the reactions are about the people and how some people are, not some inherent characteristic of a profession or discipline.
    If you receive adverse reactions and then draw the conclusion that this says something about ‘the world Acupuncture’, it seems like you are taking a skewed sample of reactionary people and then drawing a conclusion from this skewed sample ( an article like this it is not going to attract people to say well done, as much as it will attract people who feel attacked to be defensive so drawing conclusions on the basis of a limited sample of responses seems a little illogical) Pushed on this would you acknowledge that?

    • of course, these events are avoidable and thus caused by the acupuncturist. this is the case to some degree with most hans on treatments – even surgery. yet they can happen despite good training.
      and anyway, in the UK, anyone can call herself an acupuncturist.
      most of the adverse events on record are from the east – but this is also where most of the acupuncture is happening.
      i called the acupuncture world myopic because of their reaction to my papers and to the resistance they put up when we first started investigating safety – not because of the adverse reactions. sorry but you misunderstood me entirely in this respect.

    • “I know plenty of passionate Acupuncturists who are lovers of science and seek to find ways it which the scientific method can be appropriately applied to Acupuncture.”

      Sorry, but that’s just not science. That’s confirmation bias.
      Science is about falsifying your hypothesis, which I’d say is anathema to advocates “alternative reality” medicine and therapies.

  • Well, as there is absolutely zero evidence of any benefit, of any kind, from acupuncture, any risk, no matter how mild or how rare, is an unacceptable risk.

    • University of Michigan, University of Maryland, Duke, University of North Carolina, Harvard, Northwestern, University of Chicago, Sloan Kettering, and Johns Hopkins would beg to differ with you regarding the lack of evidence. You should do your homework before making such inaccurate comments.

      • another classical fallacy! actually several in a short comment – a new record?
        how much homework do you want? do >200 articles on acupuncture in the peer-reviewed literature suffice?

  • As with any intervention, the question is do the risks outweigh the benefits? Right now, any acupuncture benefit beyond placebo appears elusive. Oh dear.

  • Good evening from Japan
    Well, people writing here are most likely a lot smarter than I am, but I have about 30 years of clinical experience as an acupuncturist in Japan. Just a few words:
    “2) puncturing the heart causing a cardiac tamponade” – THAT suggests that the practioner has been aiming at the heart to begin with. No acupuncturist in his/her right mind would ever do that.
    “Three patients died, … one from an aortoduodenal fistula.” – How can acupuncture treatment CAUSE an aortoduodenal fistula??? Please enlighten me.
    “bleeding (5 in the central nervous system)” – How on earth did anyone achieve that?? Jamming a 15 cm long, nail-thick Chinese needle right through an eye or up the brainstem, I suppose.
    “We can thus estimate whether the risks outweigh the benefit, and if we find that they do, we should (and usually do) stop using them. I am not at all sure that we can perform similar assessments in the case of acupuncture.” ->
    Well, I do NOT like the Chinese style acupuncture (looks like torture to me), but the treatment form HAS been around for, let’s make it 2,500 years. During all that time it has been administered in various countries to millions of people. And all those people have been too stupid, or too “myopic” as you put it, to come to some sort of experience based (check = clinical trial), independent (not all of them have been ruled by the communist party) opinion? If the treatment were so ineffective, so irrational, so non-scientific and dangerous … why is is still in use – after a 2,500-year clinical trial!!! – and apparently gaining in popularity.

    I am sure this MUST be a hypnosis induced form of mass hysteria.

    PS: I would NOT trust ANY “information” coming from China …

    • PUNCTURING THE HEART: this usually happens in patients who have a foramen in the sternum [~6%] of the population; it happens to be right over an acu-point.
      ACUPUNCTURE HAS BEEN AROUND FOR 2500 YEARS: thank you for reminding us of this popular fallacy.
      the rest of your comments are too silly for a response, i’m afraid

  • In the Chinese study, the authors concluded: “Acupuncture-related adverse events were mainly caused by mental tension of the patient, improper operation by the doctor, and incompleteness of sterilization. Most of them can be avoided by standardizing teaching and clinical practices. Making the corresponding safety standards can greatly lower the risk of adverse events and protect patient safety to the greatest extent.”

    So 35 fatalities were noted in all Chinese literature for the years 1956-2010. From your quick summary we don’t know when these occurred, whether they occurred in rural or metropolitan areas, who was performing the acupuncture, what the patient confounding factors were, etc etc. We don’t know the detail which is, in essence, where the real evidence lies.

    If the deaths were at the hands of experienced acupuncturists in metropolitan cities with high quality sterilisation practices in the late 2000s, we’re faced with a different context in which to make recommendations than if the deaths occurred in small, rural villages with poor sterilisation and inexperienced acupuncturists in the 1960s.

    On a slightly unrelated note, to say “any risk, no matter how mild or how rare, is an unacceptable risk” is contradictory. There are plenty of risks in modern medicine. Amniocentesis and CVS, for example. A one-second Google search resulted in this study which found fatal complications of pacemaker and implantable cardioverter-defibrillator implantation. There are thousands of deaths each year directly attributed to prescription drugs.

    • ALL I NEED TO REPLY HERE IS REPEAT THE 2 LAST PARAGRAPHS OF MY POST:
      True, these are almost certainly rare events – but we have no good idea how rare they are. There is no adverse event reporting scheme in acupuncture, and the published cases are surely only the tip of the ice-berg. True, most other medical treatments carry much greater risks! And true, we need to have the right perspective in all of this!

      So let’s put this in a reasonable perspective: with most other treatments, we know how effective they are. We can thus estimate whether the risks outweigh the benefit, and if we find that they do, we should (and usually do) stop using them. I am not at all sure that we can perform similar assessments in the case of acupuncture.

    • Adverse reactions to correctly prescribed medications were responsible for over 100,000 deaths in the USA last year. Then there are deaths related to other medical interventions. The sum total makes Iatrogenic deaths the leading cause of deaths in the USA.

  • JAMA published an article back in 2002 that described iatrogenic causes as being the 3rd largest cause of death in this country. They were not looking at acupuncture, but the US standard medical system. There was a study done in Israel after all the doctors went on strike for a month. The death rate in the country went down 50% during that period. Face it medicine is dangerous. 90 Deaths by acupuncture over whatever period of time is nothing compare to the damage done by improper prescriptions, surgical error and on and on. What you have demonstrated is that Acupuncture is one of the safest methods of treated someone, not an unacceptable risk. If you are concerned about safety look at hospitals and MRSA, and unnecessary treatments, and bankrupting overcharges that destroy peoples lives. Get real!

    • Susan Andersen said:

      90 Deaths by acupuncture over whatever period of time is nothing compare to the damage done by improper prescriptions, surgical error and on and on.

      Apart from the callous disregard for human life this seems to show, what you are saying is, “Don’t look at that problem; look at this completely different problem over here.”

    • ” What you have demonstrated is that Acupuncture is one of the safest methods of treated someone…”

      I hear laying on of hands by a priest is even less dangerous than acupuncture, no fatalities that I am aware of… and about as effective.

  • did you actually read the article?
    under-reporting??
    risk/benefit???
    i think, maybe it is you who needs to get real.

  • Enjoyed reading this debate. Congrats to all the posts. I do not use acupuncture or have anything against the practice. Reading this, I understand now that there are risks associated with acupuncture. I suppose that’s not surprising. I only wish the use of Oxycontin were subject to the same scrutiny. Also, in another post you support acupuncture as an alternative to chiropractics. Something I would endorse. Everything I do carries some risk. Without an appreciation for the frequency of adverse outcomes vs. the known benefit as compared with other treatments, I am not sure how your concerns can usefully translate into actions on the part of readers.

    • “…how your concerns can usefully translate into actions on the part of readers…”
      i think this is all too obvious: once we accept that the risk/benefit balance is not positive for a treatment, we should be very cautious about using it, we should ask questions to those who want to sell it to us and we should demand further high quality evidence.

  • Edzard, I actually enjoy your skeptical attitude in this web site, but perhaps you would afford others the same? I agree that if you should never get acupuncture without a need. Is that all you’re saying? These assertions and a few random facts (1000 adverse events over all time and space) are interesting and certainly go to that. But I still don’t see how they apply to someone who requires treatment. I don’t have enough dispassionate information to assess the risks and benefits to people to this subset– perhaps you have information not in your original post? You yourself recommend acupuncture over chiropractics, do you not? It also seems likely that many pain medications debilitate millions. I think if you assert that the risks are not acceptable you need to need to be more clear and provide more information that people can use to make up their own minds.

  • my advice could not be clearer: IF FOR ANY THERAPY THE BENEFIT DOES NOT OUT-WEIGH THE RISK, DO NOT USE IT.

  • Rob Wahl said:

    But I still don’t see how they apply to someone who requires treatment.

    But this is the whole point Prof Ernst is trying to make: there is so very little good evidence that anyone requires treatment, and, given that there are adverse effects (although the full extent cannot be known, because there is no systematic method of reporting them), the balance between risk and benefits goes against it.

    The risk-benefit balance for any other treatment might well be interesting, but it does not affect that of acupuncture.

  • This is tiresome old stuff, and we have to wonder what’s wrong with Ernst that he still peddles his dubious arguments. As Michelle G points out, the 35 mortalities reported in China covered a period of 54 years from 1956 onwards – a date when tens of thousands of barely trained barefoot doctors were encouraged by the fervour of the cultural revolution to attempt extreme treatments with acupuncture needles. Ernst meets all the criteria of a fanatic, someone who won’t change his mind and can’t change the subject. He is perfectly familiar with the York acupuncture safety study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC48134/) which reported no serious adverse events in 34,000 treatments carried out by 1848 properly-trained members of the British Acupuncture Council. As for sternal foramina, an ‘abnormality’ that 6% of the population has, it’s true that they lie beneath an acupuncture point. However as every acupuncture textbook emphasises, this point should never be needled perpendicularly – the only way that would penetrate the foramen. As another study (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1743889/) has demonstrated, ‘Patients receiving acupuncture treatment that was not funded by the NHS and patients not in contact with a GP or hospital specialist were less likely to report adverse events’, it is medical acupuncturists – usually minimally trained – who are most likely to cause harm. As for Ernst’s argument that, ‘ in the UK, anyone can call herself an acupuncturist’, that is precisely why the profession is begging the government for proper registration and why someone like Ernst should be supporting this campaign, not sniping from the sidelines like the sidelined retiree that he has allowed himself to become.

    • Actually, Deadman, I wonder what’s wrong with you that you would start and finish your contribution in such a nasty manner. Do you really think that’s the way to persuade people you’ve got something worth saying? There is nothing dubious about EE’s argument that because of the lack of an adverse event reporting scheme in acupuncture one is unable to estimate whether the risks of acupuncture outweigh any benefit and your overly defensive response does nothing much to address that argument.

  • yes, it is “old stuff” that an acupuncture needle in the hands of an incompetent acupuncturist can kill. i do not see, however, why i should not inform people about this fact only because some acupuncturist do not like to hear this message.
    and what about regulation?
    the main purpose of regulation is to protect the public. as long as the regulation does now include an obligation that acupuncturists must abide by the rules of evidence-based practice [the draft i saw does not include this obligation] it does not fulfill this creterion. in this case, i suspect that regulation would merely increase the status of acupuncturists.
    THE REGULATION OF NONSENSE WILL RESULT IN NONSENSE!!!

  • Skepticat asks why the nastiness. It’s because under the guise of scientific rigour, Ernst is simply arrogant and prejudiced when it comes to stuff he’s uncomfortable with and which doesn’t fit his preconceived notions. And he’s loud, rude and very public about it. He dismisses as meaningless the fact that Chinese medicine is and has been used for billions of patients over two millennia and features in every hospital and clinic in China today. He claims this is evidence of nothing, yet human experience over centuries is the basis of most human activities and we don’t need randomised clinical trails to tell us, for example, that eating asparagus is better than eating hemlock, or that jumping out of a plane with a parachute is better than without, or that exercise is better than no exercise. The demand that every application of Chinese medicine has to be supported by gold standard evidence is not required of any other branch of human knowledge – certainly not conventional medicine, many of whose procedures are untested and which incidentally causes more iatrogenic injury and harm than just about any other factor including wars and accidents (and I am quite a fan of conventional medicine by the way – where appropriate). But even worse is that when evidence is available, it is invariably dismissed as NONSENSE. I publish a Chinese medicine journal (three issues a year) and in each issue we give brief accounts of recent research. In our February issue, for example, we give abstracts of positive acupuncture research published in the following publications: BMC Gastroenterology, The Journal of Clinical Oncology, Annals of Oncology, Gastroenterology, Neural Regeneration Research, PLoS One, Gastroenterology Nursing, Journal of Research in Medical Sciences, European Journal of Pain, Asian Journal of Psychiatry, Military Medicine, Pain, Cerebral Cortex, among others. Ernst’s response to each of these will be predictable. The trials will all be poorly conducted, the authors blinded by their prejudice in favour of acupuncture etc. etc. The evidence in favour of acupuncture mounts up by the day and Ernst, and his blinkered and diminishing bunch of sceptics, are fighting a rearguard campaign that seems doomed to failure as the tide by them. But for the present, their voices are loud and have more influence than is justified, thus potentially depriving patients of treatments that can significantly reduce their suffering. Scepticism is vital … we all need healthy scepticism and I practise it in every field I am involved in, especially the notoriously credulous field of complementary medicine. But here is a big difference between healthy scepticism (which in my opinion goes hand-in-hand with open-mindedness) and closed-minded prejudice.

    • would it be too arogant to point out that you are employing the classical fallacy of ARGUMENTUM AD POPULUM/TRADITIONEM?

    • Skepticat asks why the nastiness. It’s because under the guise of scientific rigour, Ernst is simply arrogant and prejudiced when it comes to stuff he’s uncomfortable with and which doesn’t fit his preconceived notions. And he’s loud, rude and very public about it.

      From the perspective of one who doesn’t have a vested interest in any kind of treatment, what I see EE doing is pointing to evidence that is available for anyone to examine and giving an opinion on it, which anyone is at liberty to disagree with. Obviously you do, but rather than engage with that evidence you respond with ad hominems and fallacious appeals like this one:

      He dismisses as meaningless the fact that Chinese medicine is and has been used for billions of patients over two millennia and features in every hospital and clinic in China today. He claims this is evidence of nothing, yet human experience over centuries is the basis of most human activities and we don’t need randomised clinical trails to tell us, for example, that eating asparagus is better than eating hemlock, or that jumping out of a plane with a parachute is better than without, or that exercise is better than no exercise.

      The first problem with this is your loose use of the term “Chinese medicine” as if what precisely is covered by that term hasn’t changed in two millenia. The second problem is the fact that longevity of use doesn’t equal effectiveness anyway – bloodletting, used in many cultures for many centuries, is the classic example. There are reasons why therapies continue to be used irrespective of whether they work or not; you touched on one of them in your first post when you mentioned the cultural revolution. The third problem is your use of false-to-the-point-of-absurdity analogies, which suggest you don’t understand why RCTs are necessary. I put to you the same question I put to the “medical herbalist” that commented on this blog recently:

      How do you know that the perceived benefits of your treatment are actually because of the treatment and not for some other reason?

      I trust most readers of this blog understand the difference between the kind of evidence needed to establish for sure whether a treatment works and the evidence needed for any of your examples.

      The demand that every application of Chinese medicine has to be supported by gold standard evidence is not required of any other branch of human knowledge – certainly not conventional medicine, many of whose procedures are untested and which incidentally causes more iatrogenic injury and harm than just about any other factor including wars and accidents..

      The campaign for EBM is only a couple of decades old and the demand for gold standard evidence by those campaigning for it applies to all treatments. This certainly isn’t to suggest that every treatment still used in mainstream medicine is supported by gold standard evidence – of course it isn’t! EBM has its detractors in mainstream medicine and I’m sure you know all about how the pharmaceutical industry behaves sometimes. But the last twenty years have seen changes for the better in mainstream medicine as it takes on board the need for EBM. I’ve noticed no such willingness to embrace the importance of evidence amongst altmed practitioners. I wonder why.

      Where did you find the data for your last sentence above? Got a link?

      But even worse is that when evidence is available, it is invariably dismissed as NONSENSE. I publish a Chinese medicine journal (three issues a year) and in each issue we give brief accounts of recent research. (snip) Ernst’s response to each of these will be predictable. The trials will all be poorly conducted, the authors blinded by their prejudice in favour of acupuncture etc. etc.

      But will EE’s response be predictable because the trials are invariably poorly conducted or can you give us clear examples of well-conducted trials that EE has criticised and explain to us why his criticisms are wrong? Unless you can do that, you – rather than EE – would appear to be someone with preconceptions and prejudices.

      The evidence in favour of acupuncture mounts up by the day and Ernst, and his blinkered and diminishing bunch of sceptics, are fighting a rearguard campaign that seems doomed to failure as the tide by them.

      Dream on. It seems to me that acupuncture is in danger of becoming the new homeopathy. The more poorly conducted trials that appear and the more practitioners reveal their inability to reason calmly and intelligently in defence of their chosen quackery in online discussions, the more derision it will attract. Keep up the good work.

  • Maybe acupuncture could not be the best medical treatment method, but nowadays there is not any other one, that is more harmless and better in most of the cases in which western medicine is able to offer devastating side effects without almost any kind of relief!

    • ANTAL NAGY

      Oh please. The acupuncture had nothing to do with it. Or did you miss the bit where the presenter said that she was sedated by drugs and her chest numbed?

      That programme was roundly criticised at the time for being wholly misleading. And quite rightly so.

  • It’s really interesting to step way back and think about this from a large perspective. Of course, my initial reaction to this, as an acupuncturist is . . . “Professor Ernst is crazy” – and in one way, I sort of think you are – but not because your science is ‘wrong’ in any way – but in the sense that I think you are devoting your skill as a scientist to what seems to be an obsession with what I would think to anyone with perspective and rationality would agree is such a infinitesimally minuscule priority in the world we live in. Sure, it might be an academic curiosity – your seeming fascination with the ‘lethality’ of acupuncture – and in a world amply funded with good science directed at all human concerns in reasonable proportion to their importance, why not know more about the lethality of acupuncture? But truthfully, my perspective, and I am certain it is a rational one is that the EFFECTIVENESS / EFFICACY of MANY modern medicines and surgeries is GROSSLY overreported (I think even the conservative Ben GoldAcre is starting to bring this into the public discourse), quite significantly mis-researched (very limited timeframes, very limited patient populations and usually conditions that bear very little resemblance to the real world of application) and ALSO that the adverse reporting of MANY modern medicines and surgeries is very GROSSLY under-reported – I am QUITE certain of that – I see it almost every single day in my clinic (even though there are mechanisms and structures in place for it – lets not use that as some kind of false delusional security). I just think in the big picture, this is a story of a kind of absurd misappropriation of talent and skill towards a largely minuscule matter. I am CERTAIN if we did a massive global survey of basket weavers we would find some had punctured themselves while working and bled to death. In this world that is truly over obsessed with risk aversion – although conveniently towards some things while ignoring herds of elephants in the room! – that would, most of us FEAR – lead to some bored bureaucrat (particularly in the lethal atmospheric blended quartet of science-media reporting of science- public confusion about science – regulatory relationship to science) with lots of regulatory time on their hands, issuing rather draconian decrees on precisely how basketweaving should be practiced! I have no problem with Professor Ernst’s research per se – but I do have a problem with, given ALL of the priorities facing humanity and the relative proportionate significance, how you are spending your time. It seems to largely be mischief, from that perspective. I wish you would devote your skill and talent to something of significance.

    • it so happens that alt med research is /was my job.
      it so happens that safety is the most important issue with any therapy.
      it so happens that the safety of alt med is under-researched.
      and it so happens that i believe my work [not this blog but the >1000 articles i have contributed to the peer-reviewed literature] is/was important.
      finally, it so happens that alt med proponents do not like me to tell the facts to a wider audience.
      you may think this is trivial or lacks perspective or whatever – luckily there are many who disagree with you.

    • Daniel wrote:

      I wish you would devote your skill and talent to something of significance.

      Well, as an acupuncturist, you would say that wouldn’t you?

      Believe it or not, it’s not just an “academic curiosity” and it’s not “mischief”. Those of us on the consumers’ side of the fence do want to know whether the treatments we are being asked to shell out for are safe and effective and we have good reasons for not taking the word of those promoting the therapies on this. I hope I don’t need to explain them.

      As your fellow acupuncturist points out above that billions of people have used it, finding out whether it works or not and how safe it is hardly a matter of “miniscule” importance and the same goes for any other widely-used treatment.

      However, EE is a professor of Complementary Therapies so your comments about “modern medicines” are irrelevant here, while your chosen grounds for attacking EE confirms what I’ve discovered about acupuncturists so far. You seem quite unable to defend yourselves.

      Btw, if you post any further lengthy comments here, please paragraph them to help their legibility.

  • I really want to emphasise what I think is the most important point here, Professor Ernst. I have no problem at all with good scientific research on any question worthy of investigation. Aside from the point I made above about proportionality and prioritization – in the context of which, I consider your work on this matter to be more mischief than useful, I want to make another point . . . . as smart people – we ALL know full well that we are dealing here not just with science but with, as I mentioned above, a particular Quartet . . . (1) Science, (2) Science as it Interfaces with, is interpreted by the Media, (3) Science as it interfaces with, is interpreted by the Public and (4) Science as it interfaces with, is interpreted by Regulatory Agencies – and even more importantly – the complex dynamic and interplay between and among all four of those. THAT is the real world in which we live. You know it and I know it. And I don’t think you or I are naive about the full complexity of all of it. So you MUST know very well, not JUST about the ivory tower interest in the question of the ‘lethality of acupuncture’ but very well how that question is likely to be handled / mishandled in and amongst all four of these domains. I have no doubt your understanding of that is sophisticated. If I am correct and you are not naive on these matters, you know fully well what can easily transpire in all kinds of ways if you do not handle your ‘interest’ in the ‘lethality of acupuncture’ with VERY tender gloves and go to HUGE lengths to dispense your words with tremendous care, caution and responsibility. It is really in that context that I am suspicious of your motives, your agenda, and your mission.

    • my mission statement is public since ~1993.
      my agenda is to apply science to alt med.
      my motives are those of a scientist: to try and find the truth to the questions i consider relevant.
      i think it is nore constructive to challenge the arguments than to doubt the motives of a researcher – but as you seem to be keen on motives: WHAT ARE YOURS?

  • My motives really truly are about the truth, as best as we can know it. And my life stands as a clear testament to that. And to repeat, I have no qualms about applying research to questions worthy of investigation – but I do have a couple of qualifiers on that matter – (1) the complete social context is important to me, not the ivory tower context – and in that context, the quartet of players I listed above is critical to understand and act responsibly within – (2) it is my honest appraisal that, in fact, the tools of science as it is currently incarnated – the research protocols of biomedicine, I find, from a clinical perspective, from what I do and see every day in clinic with critical eyes wide open – are woefully inappropriate for the investigative challenge at hand – and I do think the time has come for the research protocols themselves to be the subject of critical investigation and scrutiny – but that is quite a different discussion.
    By all means, continue to document matters of safety with regard to acupuncture – as I am sure you will – but do so responsibly, communicate yourself responsibly, use your power and reputation responsibly and always think of the big picture and the many elephants in the room.

    • By all means, continue to document matters of safety with regard to acupuncture – as I am sure you will – but do so responsibly, communicate yourself responsibly, use your power and reputation responsibly and always think of the big picture and the many elephants in the room.

      Nah. Just show us what the evidence says. We’ve got the brains to work out the rest for ourselves.

    • guess what, research protocols are already subject of much scrutiny. you think of it as the ivory tower? do you really understand how reserach is done?

  • And to be honest, sir . . . when you title a research paper, “Acupuncture, A treatment to Die For?”, yes, it truly does make me question your motives. The title itself is dripping with sarcasm, does not reflect a sober scientific objectivity at all, frankly, but suggests a significant bias in intent. So the question is, did you select the title or did the journal and if the journal did, why , as a purely objective scientist, did you not object and suggest something along the lines of “Death rates from Acupuncture”?

    • Whoever chose it, it’s a title that serves a title’s purpose, which is to provoke readers into reading the article. I submit that was the ‘motive’ behind that choice of title. Your proposed alternative would do that job just as well but doesn’t involve the play on words. I don’t see the sarcasm. Where is it?

      • i think it’s a very effective title. i like it because it captures the imagination of someone who might then read the article. i thought of it and do not regret it.

  • Death rates from Acupuncture???
    that would not even have been correct!
    firstly, it is not neccessarily FROM but AFTER [causality is often unproven].
    secondly, it is not a RATE at all [a rate is event per unit of time]
    you see, my title was miles better than yours – particularly as it had a question mark behind it.

  • Good point – I wrote my suggestion on the fly and it certainly could have been much better. I agree. But that really wasn’t my point. The title you chose is simply not the title of an objective inquisitive scientist – it is provocative, that is for sure. Like I made clear above, this territory is not just the territory of science – it is the complex territory of four domains interacting with each other – I think I made that clear and I would hope that you understand that! AND in THAT context AND with your power and reputation, I am simply suggesting that you communicate with the utmost of responsibility and care. I would suggest that choosing titles like that for your articles in not communicating with responsibility and care but rather, irresponsibly and carelessly and reveals that you either do not appreciate with sophistication the points I have made above (which would surprise me, but I may be left to conclude that, given your response) OR that you do have an agenda beyond the mere objective interest you claim.

  • “The title you chose is simply not the title of an objective inquisitive scientist”
    how do you know?
    you make big judgements here claiming that i am not “communicating with responsibility and care but rather, irresponsibly and carelessly” . that is YOUR OPINION as an acupuncturist. my opinion as an independent academic scientist differs from yours.
    THEY WOULD SAY THIS, WOULDN’T THEY? see more on that subject here: http://edzardernst.com/2013/02/they-would-say-that-wouldnt-they/

  • Edzard, would you mind commenting on the York acupuncture safety study cited by Peter Deadman above? Unless you refute its findings, surely you can understand why we trained acupuncturists find it hard to accept that there isn’t a bias to your approach. I would agree with Daniel that the title you chose for your article seems to reveal a lot – it is alarmist at the very least. Why shout from the rooftops about these historic adverse events from poorly trained practitioners when there is good, contemporary science to show acupuncture is one if the safest therapies there is when properly administered? Wouldn’t the rational, balanced approach be to mention the alleged fatalities, putting them in their proper context, but just as importantly to reassure the public that a recent large-scale study confirms the outstanding safety record of well trained acupuncturists?

    • ok, this study is of the UK situation; my post is not focussed on the UK. like all such studies it suffers from self-selection. until there is no reliable system of adverse-effects monitoring, nobody can make firm statements about the safety of acupuncture. my post is not alarmist but tries to tell the facts as they are.

  • instead of commenting on the title of a paper published some time ago elsewhere, how about focussing on this post and its title: ARE ACUPUNCTURISTS IN DENIAL? it seems to me that some of the comments are aimed at convincing us that the answer is YES.

  • In denial? No – I think most acupuncturists would admit that putting needles in someone’s body without proper training will occasionally result in serious injury – pretty self evident. What we object to is the angle you choose to take under the guise of science, which is overwhelmingly and consistently negative. You say your post is not focused on the UK, but would a rounded scientific discussion not at least mention this study and draw the conclusion that acupuncture is safe in the right hands? That is certainly not the message you have promoted.

    Anyway, I’m sure I’m wasting my breath (or typing fingers) but I think there are legitimate and constructive criticisms here.

  • Are acupuncturists in denial?

    The research you mention confirms that acupuncture has been associated with severe adverse reactions, and in rare cases even death.

    However, the recommendations from the research, as well as the York study demonstrate that these adverse events are avoidable where acupuncture is administered by appropriately trained practitioners (regardless of whether they are in the UK or elsewhere).

    As an acupuncturist, your post served to remind me of the importance of the safety protocols that were emphasised in my training, in terms of both clean needle technique and cautions/contraindications of acupuncture points. Already careful when using potentially risky points, I will probably be even more so having been reminded of the potential for such severe adverse effects.

    As Peter Deadman points out, every acupuncture textbook (at least all the ones I have seen) highlight such cautions and contraindications.

    The British Acupuncture Council (BAcC) require all their members to follow an evidence-based code of safe practice. More recently, they have piloted an adverse incident reporting scheme which is now (as of January 2013) being rolled out across the membership. Hopefully in time, this will provide more robust evidence as to how common adverse events really are (though they will no doubt continue to be underreported in the same way as with adverse events reporting in conventional medicine).

    Acupuncturists (at least those who have been properly trained, most easily demonstrated in the UK by membership of the BAcC) are well aware of the importance of safety in their practice. They are not in denial about the potential risks of poor practice.

    I’m not certain that the same can always be said of medical acupuncturists, physiotherapists, chiropractors and others who practice acupuncture or dry needling after short (sometimes weekend) courses. And, as you point out, anyone can call themselves an acupuncturist in the UK without any training at all. Again, this is the very reason that the BAcC has been asking for regulation.

    I acknowledge that providing acupuncture treatment is not completely without risk, so the question remains whether the risks outweigh the benefits.

    There have been some good quality trials demonstrating the effectiveness of acupuncture. In the BBC 2 documentary, ‘Alternative Medicine, The Evidence’, I noticed a clip where you (Edzard Ernst) say:

    “The Burnham trial shows that acupuncture is effective for one specific indication. The trial is well-designed and therefore, I personally trust its results. It convinced me that acupuncture works for knee osteoarthritis.”

    Although many acupuncture trials are small (due to cost), or are not so well designed, the evidence base is increasing. This, despite the difficulties with designing trials for acupuncture (well beyond the scope of this post).

    While not everyone may not be satisfied by the evidence, there has been sufficient evidence for NICE to recommend acupuncture for low back pain and tension headaches.

    Finally, regardless of the research evidence base, many people will continue to choose to try acupuncture treatment for other reasons, especially anecdotal evidence. Regulation would help to ensure the treatment these people seek is as risk-free as possible.

    Certainly for my patients, many of whom have seen a dramatic improvement for a wide range of symptoms (whether due to placebo, the active effect of acupuncture, or a combination of the two), usually where conventional medicine and other therapies have been unable to help, the benefit has outweighed the risks.

  • Come on Professor Ernst – seriously.. . . . “Acupuncture – A Treatment to Die For?” I am totally in favour of investigating everything and reporting on everything. I can state and defend entirely that I, for one, am not in denial. I face the work I do in my clinic every day with as much brutal honesty as I possible can and I challenge every single one of my patients to do the same. For me this is not about denial at all. It’s about integrity. By ALL means, lets have a big large wide open discussion about all of it – put everything on the table (including the currently esteemed protocols of science themselves which should be available for, open to and under just as much inquisitive examination as things like acupuncture) – BUT HONESTLY . . . this title selection for an article in a scientific journal – big judgements? my opinion? Seriously? Its a mischievously provocative, smug and sarcastic title and I wish you could be big enough to admit that. It does not serve the mature and intelligent discussion we should all be involved in at all – it diminishes it. And given my reasonable understanding of priority and proportion in these matters – it’s quite irresponsible. I really do wish, in the interest of moving the very important discussion we are all involved in here, that you could make yourself available to admit that.

  • Hi, I’m not from the UK and therefore I’m not familiar with your NHS. Besides political will what would be necessary to create a reliable adverse event reporting scheme – exempt from bias of any source? Which model and how should its internal structure be? Other medical procedures in the UK are also monitored this way? How? Regards

    • Hi Pedro

      Basically, adverse incident reporting schemes operate throughout the NHS and are the responsibility of local NHS Trusts. If you google something like ‘nhs adverse incident reporting’, I’m sure you’ll find fuller information about them.

  • The largest likely perspective I can discern at this time regarding Deaths associated with Acupuncture (I do understand the difference between association and causality so please don’t patronise me) . . . by all means, we should investigate everything to the full extent we can – and I have no doubt if we investigate further we will find an incidence of deaths associated with acupuncture we were previously unaware of – it’s quite likely. And for sure, we should know about it and translate that into response and action. That is, of course, the way everything should work. And just because there are adverse event reporting mechanisms in ‘mainstream’ medicine (please don’t sideline into a quibble about that choice of terminology – yes, its not perfect, etc etc but terminology is not ideal in such discussions, ever) – there is little doubt that at present such mechanisms very significantly under-report . . . that should be an obvious fact to anyone working in the trenches of health care with their eyes wide open. I could be wrong and if I am, so be it – I’ll be the first to admit it if that is revealed, but I would say it is most likely – in fact, highly likely that in the ideal world with some ideal of perfect reporting in all these domains, we would find that deaths associated with acupuncture and deaths associated with many drugs and surgeries are MANY ORDERS of magnitudes apart – I would be REALLY surprised to find this guesstimate to untrue (which is NOT to say, don’t investigate! By all means do! We want to know and we want to respond reasonably). Given that likelihood – it is just downright irresponsible (given the likely response in the domains of media reporting, public interpretation and regulatory response – three domains I introduced above that are NOT in reality separate fro the ivory tower of academia in which you work) to title a report on deaths associated with acupuncture , “Acupuncture-A Treatment to Die For?”. It’s just not responsible. If you are really interested in reasonable discourse and all of us moving forward together, you would understand that. Such a title does make your motivations and intentions, given the LARGE context I am painting here, despite what you state them to be, highly suspect – but perhaps that is a level of honesty you yourself have not even subjected yourself to? I don’t know. I don’t know you at all. I am pretty sure I am being reasonable and proportionate here in my comments. Something to consider —- if you live in the world of objective science and it does become clear, lets say, just for the sake of argument – that the Deaths Associated with Acupuncture are revealed to be MANY ORDERS of MAGNITUDE less than Deaths Associated with Surgery or some medications – and you have already ‘used up’ the “Acupuncture-A Treatment to Die For?” title, what would be an appropriate title then for an article you might write in the same journal at some point on Deaths Associated with Surgery, for example – or Anti-Depressants. And PLEASE – spare me the ‘They Would Say That’ tangent – I understand that reference and everything it points to, I really do – but it is also a stereotype and promptly shuts down discussion which, as a scientist, I presume you are in favour of. My interest here is first and foremost – reasonable and proportionately appropriate discussion.

  • what i find fantastic is that several people casting aspersions towards acupuncture on this page ask for robust evidence supporting safety and effectiveness of acupuncture, statign none exist. Then when they are presented with some * they go very quiet, i’m sure only to bring up similar comments elsewhere. * For example the York study (cohort of 34,000 with zero advers effects seems reasonable), and a review of acupuncture treatment of back pain which led to its recommendation in the NHS NICE guidelines.

  • As Mr. Ernst states, “True, these are almost certainly rare events – but we have no good idea how rare they are.” He makes the assumption these are “the tip of an iceberg” and yet, after tens of millions of treatments performed worldwide he has found barely 1000 “serious adverse effects” and a total of 35 deaths which might have been related to treatment. Compare this to the yearly fatality and injury rate skiing (traumatic brain injuries alone over 5000 per year) or the rate of iatrogenic death and illness in biomedicine and we quickly see this is much ado about nothing. Far more children die in a month riding bikes than the sum total of incidents in the entire literature pertaining to the practice of Chinese medicine over decades. Is it reasonable to have excellent training and accurate reporting of adverse effects? Sure! But this issue really is a diversion from a mature and serious conversation regarding models of medicine and health care.

    • after tens of millions of treatments performed worldwide he has found barely 1000 “serious adverse effects” and a total of 35 deaths which might have been related to treatment.

      You don’t seem to have grasped his point about the lack of an adverse event reporting system. You do realise he hasn’t looked all “tens of millions of treatments” don’t you?

  • sorry, i did not have time in the last 2 days to keep on top of things here. reading the various comments, i am struck by the feeling that acupuncturists do a lot to confirm my fear that, in fact, they are in denial. perhaps not in denial of the principle that acupuncture can cause harm, but in denial about the question whether this is important.
    they say it is not the acupuncture but the incompetence of some acupuncturists. i agree – but this does make the subject not less important, in my view.
    they say that these cases are not UK patients. i never said they were – this bolg is read internationally, i hope.
    they say these are rarities; yes, we all hope so but we need data not assumptions and, crucially, we need to take the huge amount of under-reporting into account.
    they say look at drugs, they are much more dangerous. i agree but in what way does it absolve acupuncturists to from getting their act together and create a proper surveillance scheme (as it exists for drugs). only when we have that will we have evidence. where is the acupuncturist who forcefully calls for a transparent mechanism to monitor adverse events???
    they say i am alarmist. i deny this and suggest it is almost impossible to be alarmist about the fact that some patients have lost their lives.
    I THINK THIS EXCHANGE HIGHLIGHTS IN AN ALMOST CLASSIC FASHION HOW FAR BEHIND ACUPUNCTURISTS ARE WITH THEIR DEFENSIVE VIEWS AND RAMPANT DENIAL OF PROBLEMS.

    • As I mentioned above, the BAcC has been piloting an adverse incident reporting scheme, which is now being rolled out across the membership. I’m sure it won’t be a perfect solution, but it is certainly evidence that safety and adverse incidents are taken seriously and are something acupuncturists are keen to measure. It’s certainly not something we’re in denial about or think is unimportant.

      I’d argue that this is an example of acupuncturists “getting their act together and creat[ing] a proper surveillance scheme” – however, as we know, at least in the UK, acupuncture is not a regulated profession, membership of any professional body is voluntary, and acupuncturists are (almost exclusively) self-employed. I’m not sure how you’d expect to enforce any kind of compulsory adverse incident reporting scheme in this context. Perhaps another reason to support the regulation of the profession?

      • Richard Agnew said:

        As I mentioned above, the BAcC has been piloting an adverse incident reporting scheme, which is now being rolled out across the membership.

        Can you give us the URL of the public access page?

  • Professor Ernst – please read what i have written carefully – ‘Rampant Denial’?? ‘Defensive Views’?? I really truly do not understand what you are talking about. I have gone to considerable lengths to write with CARE so that our discussion can precisely move beyond the interpretations you have JUST articulated – I have gone to great lengths to express an openness to your pursuit of investigating Deaths associated with Acupuncture – I have gone to great lengths to establish a larger context for why it is nevertheless important – despite AND in addition to what you say – to consider the essentially reasonably very likely relative importance of this problem vis a vis Acupuncture and vis a vis Drugs / Surgery and I have gone to great and repeatedly patient lengths to spell out the reality of the academic-public-media-regulatory interplay within which this should all be handled reasonably and responsibly and all you CONTINUE to do is reply with the clearly very very very entrenched stereotypes you seem to be very committed to regarding acupuncturists. I remain patiently committed to such discussions within a commitment to proportion, rationality and priority that reflects reasonable perspectives and sophisticated and mature engagement between professionals. As far as I can tell, we don’t seem to share that overarching commitment. It’s very unfortunate. I do wish it were otherwise.

    • Considerable lengths, yes, care, no. One of your sentences above is 145 words long! Why should anyone read what you’ve written carefully when you won’t afford your readers the basic courtesy of using punctuation and paragraphing? Your comments read like verbal diarrhoea.

  • Basic Courtesy? You mean like using my real name rather than hiding behind a childish moniker?

    • I couldn’t care less what you call yourself, Daniel. Why would anyone care? Names aren’t important – arguments are. But yours frankly aren’t worth the effort it takes to decipher them. Ignoring a polite request that you put paragraphs in your comments to make them more legible, continuing to post long, wearisome and repetitive blocks of badly punctuated text and demanding that they be read “with CARE”, probably isn’t the best way to win hearts and minds.

      Just saying.

  • I have certainly experienced a VERY broad range of diversionary red herrings in these kinds of dialogues, but this is a first – paragraph indentation! I have raised good points with care and only repeated them because they either have not been addressed, or been addressed poorly. Paragraph insertion is a triviality. As is – in the VERY LARGE REAL WORLD, ‘deaths associated with acupuncture’ (in ALL reasonable likelihood).

    But to agree with BAcC and presumably you and Professor Ernst – of course – every health care profession should have a good adverse event reporting scheme in place. Acupuncture is a relatively new profession – as it gets more organised, I have no doubt, such an appropriate framework will develop and mature. I don’t know a single working acupuncturist who would stand in the way of such a development. Do you? Has anyone here ever met a working acupuncturist who argued that their profession should not have a formal adverse event reporting scheme? If so, they should be challenged, and I’d be happy to do that.

    This discussion is not about that. For me, it’s about a mischievously provocative title of an article, a title that I consider irresponsible for all the reasons I have mentioned above. And it’s about shouting about a flea when there are herds of elephants in the room. That is not denial. That is not avoidance. That is just being reasonable, mature and proportioned.

    • You haven’t raised good points and you certainly haven’t done so with care but if you don’t have the maturity to grasp the need to express your arguments clearly and legibly, then I can’t help you. Nice try, btw, calling it a ‘diversion’ but the evidence is visible on this page and it is against you.

      There is nothing to “discuss” about the title of a paper published two years ago. You’ve expressed your opinion about that title, you don’t like EE’s response. End of ‘discussion’. The title is out there and won’t be changed. Get over it.

      It’s interesting to learn of your enthusiasm for adverse event reporting schemes. As you would seem to be the Chairperson of a professional association of acupuncturists, perhaps you could tell us how your scheme works? I can’t see any mention of it on your website, which is surprising, seeing as your Association is ten years old and I’m sure that finding a way of establishing the safety of what you’re selling was your first concern.

  • Skepticat_UK, you’ve just made my point perfectly. You know my name because I am interested in mature, responsible, open and transparent dialogue. And since I have given you my name, you have searched and learned things about me and are now using that information to ‘further’ your engagement with me.

    I have nothing to hide and would be more than happy to discuss our Association’s approach to adverse event reporting and the other points you raise above. However, I have no idea who you are. You hide behind an adolescent moniker and when I click on that, I get an entire blog-site that is equally anonymous and cloaked. When you change your Identifier to your real name and make your real name up front, transparent and evident on your blog and website, for all to see – and it can easily be confirmed – the validity of who you are and who you claim to be, then I will be more than happy to take this conversation further.

    But until that happens, I don’t joust at windmills and I certainly have no interest in talking with a hooded teenager who is now taking advantage of the gross asymmetry in our understanding of transparency and mature dialogue.

    • Daniel, I am sorry if I’ve given you the impression I wish to further my engagement with you but please rest assured that there is nothing I could want less. My purpose was simply to point out that, in spite of your professed enthusiasm for adverse reporting schemes, your Association doesn’t appear to have one. Readers of these comments will notice that you use my anonymity as an excuse not to avail yourself of the opportunity to explain this and will undoubtedly conclude, as I have done, that you do indeed have something to hide.

      If you don’t have sufficient human empathy to understand why some people choose to be anonymous on the internet, I pity you. My real name is actually on my blog and can be found by anyone who reads it. Ciao.

    • I’m neither hooded nor a teenager. My most pressing question about acupuncture is this: given that we now know there is no such thing as qi and no meridians along which it flows, has your association worked with its members to remove all mention of qi and meridians from all materials and consultations?

      Has your association also distanced itself from johnny-come-lately delusions such as auricular acupuncture, based on the homuncular delusion?

  • Guy, without wishing to offend, your comment about Qi sums up for me the arrogance that a purely reductionist, scientific approach can sometimes foster. ‘If it can’t be measured, it can’t be ‘real”. Is love ‘real’, for example? I will respond further when I have a chance, as I realise this isn’t enough on its own.

  • Well, all I can say at this point is ‘Its all very fascinating’. From time to time, I spend time on some of the ‘Skeptic Sites’ and it really is fascinating for me to read the content, the sentiments and perspectives being expressed. You know, interestingly, I myself am driven by a strong interest in validating and confirming. I am on the clinical side of the acupuncture world – a world I entered about 17 years ago as a skeptic myself – and i have truly had, with, I can assure you, my eyes wide open – very impressive validation in my clinic (SORRY Skepticat – that was probably a disastrously punctuated mess for you!!). The meridians exist? No question about it. I and my patients see them validated in clinic every day. I really truly would not stay in practice if I thought I was just practicing a grand delusion. But I do think . . . and I KNOW you have all heard this argument many times and dismiss it handily with a ‘they would say that’ wave of the hand . . . I do think in all honesty that what really transpires in a good honest down to earth series of acupuncture treatments is fundamentally not amenable to good testing by the current protocols of modern biomedicine. I know. I know. You’ve heard that before. I know. I know. When I say that sort of thing . . . . at this point, all you hear is likely some version of ‘bla bla bla’. It’s too bad. Because it really does mean there is NO dialogue to be had here. And it really does seem there isn’t. It is clear the Skeptics – as a generalisable group – have it all sewn up in their minds. They are on a mission. They are determined. What I find most fascinating, as an observer of culture is that I know of just as many doctors, physicians, scientists, biomedically trained professionals . . . who are engaged with (in my case) acupuncture – even studying it, practicing it, using it, promoting it. It’s just plain fascinating to observe that world bifurcating like that. That in itself would make for a great study!!

  • And I will add that I do find many – certainly in the acupuncture world – and in the larger alternative medicine world – say crazy things all the time – things that make me shudder. To be honest, I find just as much craziness on ‘both sides’ of the fence. I think the CAM scene needs to ‘tighten up’ and I think the Skeptic scene needs to ‘lighten up’. And I can only hope that the future – a constructive future – is available to the few sane folks who can do that and come together with all their critical capacities engaged. When I look forward, I am JUST as unnerved by a potential future steered by New Age Flakes as I am by a potential future steered by Skeptic Dinosaurs. Both need to get out of the way.

  • Qi is a highly complex idea, which encompasses the ebb and flow of everything in the universe rather than simply that which is influenced by the insertion of needles under the skin. It is a concept that comes from the careful observation of nature by tens of thousands of brilliant minds over many centuries, and it is central to Chinese thought and culture. To dismiss it in the way you did above is extremely disrespectful in my opinion.

    To briefly discuss my own concept of channel Qi (which you seem to be referring to), I see it as an elegant and clinically useful analogy, and not necessarily ‘real’ in the sense that there is a physical substance separate from blood, nerve impulses etc. The collection of points that run up a particular part of the leg and into the abdomen, for example, have become known as the Spleen channel, and they have a certain overlap in function. But when I needle these points, I have no doubt there are all kinds of physical reactions occurring including the release of hormones, instigation of the inflammatory response, stimulation of nerves etc. All of this is Spleen channel Qi to me, and the label it is given is not important. I happen to prefer the Chinese concepts to the Western ones, partly because the former have been clinically applied for far longer, and also because they simply strike a chord with me in a way that reductionist science does not.

    And the same can be said for many patients of mine, who find this approach to health and disease to be far more interesting and meaningful to them than Western medicine. To my mind, both paradigms have their important place in our society, and neither will suit everybody.

    • “The subluxation is a highly complex idea, which encompasses the ebb and flow of everything in the universe rather than simply that which is influenced by spinal manipulation. It is a concept that comes from the careful observation of nature by tens of thousands of brilliant minds over the last 120 years, and it is central to chiropractic thought and culture. To dismiss it in the way you did above is extremely disrespectful in my opinion.

      To briefly discuss my own concept of the subluxation (which you seem to be referring to), I see it as an elegant and clinically useful analogy, and not necessarily ‘real’ in the sense that there is a physical manifestation separate from blood, nerve impulses etc. The collection of displaced vertebrae that run up the spine, for example, have become known as Vertebral Subluxation Complexes, and they have a certain overlap in function. But when I manipulate these points, I have no doubt there are all kinds of physical reactions occurring including the release of hormones, instigation of the inflammatory response, stimulation of nerves etc. All of this is a subluxation to me, and the label it is given is not important. I happen to prefer the chiropractic concepts to the Western ones, partly because the former have been clinically applied for far longer, and also because they simply strike a chord with me in a way that reductionist science does not.

      And the same can be said for many patients of mine, who find this approach to health and disease to be far more interesting and meaningful to them than Western medicine. To my mind, both paradigms have their important place in our society, and neither will suit everybody.”

  • Ah, I see what you’ve done there Alan. You’re saying that anyone who allows themselves to engage with anything not fully accepted and understood by science is equally delusional, and that all CAM therapy theory is interchangeable nonsense. Except you made the point with exquisite satire. Well, that showed me.

    Today, I had the pleasure of helping a man with ‘untreatable’ numbness in his feet make a significant breakthrough. A spinal injury patient told he would never walk again showed me a video on his phone of his first steps with the help of a frame (the spinal unit are so impresed with his progress that they are looking into trialling acupuncture for all their patients). I saw a lady who before she came for acupuncture a year ago had almost daily debilitating migraines – she has had 3 or 4 mild headaches since then, and only when taking Western medication for other reasons. I saw an elderly lady whose crippling plantar fasciitis is 50% better after a few treatments. I could go on, and most acupuncturists will have similar experiences every week in their clinics.

    I’m sorry if some people find the concepts involved too uncomfortable to stomach, but I for one enjoy being able to offer a safe and effective alternative to people who often feel abandoned or let down by Western medicine. Hopefully the day will come when patients are routinely offered the best of both worlds.

  • I’m not at all uncomfortable about it. It sounds as Qi can mean whatever you want it to mean and that it’s essentially similar to the “vital force” idea common across many cultures in pre-science days. But, unlike love, it can’t be pinned down, identified and measured. Like gods and leprechauns, there’s no evidence it actually exists.

    Call it ‘arrogance’ if you like but that is the truth of the matter.

  • Love can be ‘pinned down, identified and measured’? Please explain.

    My point was that, unlike gods and leprechauns, the theory of channel Qi is a clinically useful one, whether or not it is ‘real’ in the sense that it can be measured. Why does a point between the first and second toes increase blood flow to the uterus? Maybe there are fascial connections that trigger it, maybe nerve pathways, I don’t know. Whether I give it a scientific name, or describe it as stimulation of the source point of the Liver channel makes no real odds to me – I know it has certain effects, and the traditional Chinese ideas guide my clinical decisions in a tangible way. Maybe one day we’ll be able to give all these techniques scientific names and describe exactly what’s going on in your reality too. But I’m happy with what the poetic and fascinating framework I’ve got, and so are many patients – isn’t that OK?

  • Imagine a bowl of flour and water, left covered by a window for a week or so. Compared this with a bowl of flour and water just mixed. The former will have risen and will form bread when baked, the latter will not.

    Is the former mix rising because it’s being left by a window? Even it happens every time it is not necessarily the cause (as we now know).

    It is my opinion that if you are really fascinated by acupuncture (or any other practise for that matter) as a treatment, you would want to work hard to understand why it works and not simply be content that it does, for the achievement of discovering the ‘why’ will push human life forward a step.

    If you are already doing this, I apologise.

    To move past this argument, both sides, I feel, must admit that they are guilty of prejudice and confirmation bias of some description.

    It is not sufficient to dismiss acupuncture (or any other treatment) because there is no scientific evidence to back it up, because that may merely point out that either no (or little; or poor) research has been undertaken, rather than disproving the effect of the treatment. I don’t think anyone can deny the correlation between acupuncture and *some* effect on the human body.

    It is equally insufficient to dismiss the importance of scepticism as a driving force for proper scientific evidence. I feel it falls to the practitioners to prove the causation, for correlation is (or, rather, should) no longer be satisfactory.

  • People should take notice of you Professor Ernst , I am suffering serious damage internal damage , its horrendous what has happened to me , I had electroacupuncture into my scalp neck and spine , I cant function at all , my memory has gone , he went into the back of my neck I know I have brain damage , my fingers move on their own my body jumps I get twitching every where , I know I have damage to the nervous system , and my scalp tissues have been destroyed , my scalp had a fluid movement and now I get an oral fluid I had to get it tested by forensic its connective tissue, collagen, and adipose cells these are from the scalp tissues,
    its from the fascia .
    I think people should take more notice of you more than ever , my life has been ruined , I cant go out anymore.

  • As a Chinese Medicine (CM) lecturer, I consider systematic reviews such as those by Professor Ernst important. Thank you. I have made it a point for my students to look at your review.

    I can understand why the review might be seen as an attack on the profession, but I don’t really think so. Remember, EBM is still only a relatively recent occurrence in the course of medical history, but has significantly influenced how medicine is practiced today by ‘attacking’ established thought (for something recent, consider Prof. Barry Marshall’s contribution.) Even now, conventional medicine is still in a state of flux. However, what EBM research has has settled will make conventional medicine appear more compelling, singly on the basis that there has been time to gather the evidence.

    When it comes to CM research, there is some good science, but there is also quite a bit of poor science out there – whether it supports CM or not. When compared to conventional medicine, CM research is still in its infancy and its quality is hindered by a range of issues – lack of scope, public interest, personnel, funding, lack of theoretical uniformity, conflict of interest and most importantly – poor study design and methodology – being some of them. These issues are yet to be properly resolved to the satisfaction of all stakeholders. But, we have the tools and ability to improve CM practice, so why not use them?

    At the end of the day, we must remember that the scientific method works in increments. Truly ground-breaking findings are few and far in between, and require extensive investment in terms of time, energy and effort. (Or, dumb luck.) Until our issues are resolved, until much more work is done, until the evidence is in, we are effectively arguing blind.

    As Prof Ernst states, it is uncertain if cost/benefit analysis can be applied to acupuncture. Therefore, at present CM can only continue as conventional medicine does where there is an absence of evidence – practice according to accepted regulatory and/or peer professional standards and relying on clinical efficacy until the evidence suggests otherwise. Meanwhile, we should be working to improve our regulatory and educational infrastructure which, as shown in Prof Ernst’s review, may help to preclude us from unfortunate patient outcomes. We should also take a page out EBM, and improve our ability to critically appraise studies both for and against CM in order to improve CM delivery to patients.

    Ultimately, patients have the right to participate and make choices in regards to their own healthcare. They are the ones who determine what is or isn’t an acceptable risk and whether or not they consent to our interventions. Not us. However, our duty of care requires us to reasonably foresee potential harm that arises from our interventions. Adverse reactions and even death as a result of acupuncture may be rare, but they are material risks that we should be aware of. Highlighting such risks can only be beneficial, not detrimental, to CM.

  • Please can anybody help me I am wanting to know if Electroacupuncture can cause muscle , tendon , ligament tears because the current is too strong and the treatment too long, by an untrained therapist.

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