MD, PhD, FMedSci, FSB, FRCP, FRCPEd

If we listen to acupuncturists and their supporters, we might get the impression that acupuncture is totally devoid of risk. Readers of this blog will know that this is not quite true. A recent case report is a further reminder that acupuncture can cause serious complications; in extreme cases it can even kill.

A male patient in his late forties died right after an acupuncture treatment. A medico-legal autopsy disclosed severe haemorrhaging around the right vagus nerve in the neck. All other organs were normal, and laboratory findings revealed nothing significant. Thus, the authors of this case-report concluded that the man most probably died from severe vagal bradycardia and/or arrhythmia resulting from vagus nerve stimulation following acupuncture: To the best of our knowledge, this is the first report of a death due to vagus nerve injury after acupuncture.

In total, around 100 deaths have been reported after acupuncture in the medical literature. ‘This is a negligible small figure’ claim acupuncture fans. True, it is a small number, but it could just be the tip of a much larger ice-berg: there is no reporting system that could possibly pick up severe complications, and in the absence of such a scheme, nobody can name reliable incidence rates. And even if the numbers of severe complications and deaths are small – even a single fatality would seem one too many.

The deaths that are currently on record are mostly due to bilateral pneumothorax or cardiac tamponade. The present case of vagus nerve injury seems to be ‘a first’. Perhaps we should watch out for similar events?

IF WE DON’T LOOK, WE DON’T SEE.

23 Responses to Acupuncture: a treatment to die for?

  • This sounds like the case of a teacher of me who is dead just after acupunctur regarding headache – that’s about 30 years ago… – so, there will be more cases out there like that one – officially unreported

    • 100 is a very small number compared to the over 70,000+ individuals that died from medication in 2016 alone. We have to put things into perspective if we want to understand them. Western medicine is brilliant, and highly effective. Unfortunately it also does a lot of harm. To check my stats: http://www.drugwarfacts.org/cms/Causes_of_Death.

      • “We have to put things into perspective…”
        EXACTLY!
        That’s why we have to put risks in relation with benefits. For acupuncture and most other alt meds: no or very little proven benefits vs finite risks. For most alt meds the risk/benefit ratio is therefore not positive.

      • @ William Ode on Wednesday 12 October 2016 at 04:3

        Medical doctors (not pretend doctors such as chiros) treat real diseases that can maim, impair, permanently incapacitate, or kill. Acupuncturists treat the worried well who can afford it, and they do well with self-limiting conditions, issues that regress to the mean, and those at the end of their cycle. Other than that, it is a placebo.

        As I’ve said to alt-meds, by all means use acupuncture when you develop a cancer. Au revoir.

  • IF WE DON’T LOOK, WE DON’T SEE.

    I think it is worse than that. As can be demonstrated beyond the reasonable doubt in one specific case (Kim Tinkham), quacks do not only not look for adverse events, they also do not report adverse events, serious or not, and they actively (try to) hide the ones they do know.

  • How could sticking needles in someone NOT carry any risks?

    • You really have to wonder that every time you give blood.

      • @jm,
        Is there chance you could make sense rather making feeble attempts to be a smart-arse?

        • Frank – what part don’t you understand? Joyce mentioned risk with needles. Giving blood requires the use of needles. There’s inherent risk in giving blood. Pretty straightforward – not sure where you’re not following.

          • “Frank – what part don’t you understand? Joyce mentioned risk with needles. Giving blood requires the use of needles. There’s inherent risk in giving blood. Pretty straightforward – not sure where you’re not following.”

            jm,
            I’ll try to write this in crayons, just for you.
            `
            Giving blood is a MEDICAL procedure conducted by trained professionals for the purpose of taking blood for scientific analysis or for storage for use by others. A needle is inserted into a specific blood vessel and blood extracted for a specific purpose.
            `
            Acupuncture, on the other hand, is about sticking needles all around the body for NO SPECIFIC purpose other than acting as a short term placebo. Even used for that purpose, it has real dangers which the good prof has written about.
            `
            There, was it that hard?
            `
            jm, what is your brand of alt-med because you have not disclosed that, as far as I’ve seen?

          • You crack me up Frank. Carry on!

          • I repeat;
            “@jm,
            Is there chance you could make sense rather making feeble attempts to be a smart-arse?”
            and
            “jm, what is your brand of alt-med because you have not disclosed that, as far as I’ve seen?”
            `
            What won’t you answer this simple and easy question? Are you ashamed of what you do?

    • There is no apparent risk……………………………………………. at the time.
      It is very convenient for acupuncturists; the victim dies later and elsewhere. Ergo, no responsibility.

  • If you do acupuncture my way, as I previously explained, there are no risks involved other than perhaps allergic to stainless steel.

    • How do you know there is no risk? You don’t follow up and you don’t keep records for that purpose.
      `
      Are you also suggesting that other acupuncture poses a risk and yours has no risk whatsoever?

  • In a recent discussion (elsewhere) regarding the merits (or rather lack of them) of acupuncture in pregnancy and childbirth, I found it necessary to demonstrate the ludicrous pseudo-scholarship supporting the practice of acupuncture in general.
    I decided to use an old acquaintance, the only point in close vicinity to the most sensitive parts of our bodies, the “Conception-1 vessel” point. In all the different varieties of acupuncture guidance charts, for some reason the external genitalia are spared. This point is not only special for its sensitive location but all the more for its purported uses.
     
    I did not find my old notes so I googled “drowning and acupuncture” and found this hilarious example I was previously unaware of.
     
    Suggested uses for this puncture point, according to the article:

    Regulates Yin
    For yin deficient headaches
    Cold penis – a condition usually but not always associated with a lack of sexual desire
    Amenorrhoea and irregular menses
    Heat in the chest
    Pain in skin of the body, especially of abdomen and perineum
    Impotence, infertility and sterility, possibly frigidity
    Calms the Mind: used for mania but can be used in less extreme conditions
     
    Do please realise that this point is only very seldom the first point to think of when trying to regulate Yin. Many other acupuncture treatments regulate Yin, and lack the sexual connotations connected with Huiyin. Using this point on a whim could, if its use were misconstrued, adversely affect your right to practise acupuncture.
     
    Regulates the genito-urinary area
    Inability to urinate or defecate
    Hernia
    Anal and vaginal problems (see also below)
    Pain in the urethra, the penis, anus, labia, vulva or vagina
     
    Drains Damp and Damp-Heat
    Pruritis vulvae – intense itching of the vulvae
    Swelling in the vulva and vagina
    Anal itching
    Constant erections
    Swollen testes
    Chronic piles
    Prostatitis and swelling of the prostate
     
    Resuscitation
    In coma or after shock
    After drowning. Some sources say that acupuncture here to a depth of 1 inch (2.5cms) which is more than recommended for normal treatment, will produce urination and defecation if the patient is alive. If otherwise, not.
     
    Regulates Yang
    Prolapse of anus, vagina or uterus
    Enuresis (involuntary urination)
    Involuntary Seminal emissions
    Sweating of the genitals

     
    It seems that many texts are unanimous in their recommendation to use this unique point, located in front of the anal orifice, for resuscitation of the drowning[sic].
    I especially noted the sentence in the text where it says:

    Textbooks suggest half to one cun but in practice about half an inch, unless the patient is drowning, when up to an inch may be used.

    The mere suggestion of a moron emergently puncturing the prostate (that’s where you most probably end up an inch or so into the body in this localisation) of a drowning victim in distress, makes one shudder.
    On top of that, this area of the body is usually colonised with pathogenic bacteria so the likelihood of introducing an infection is considerable. One cannot but doubt the mental sanity of the inventors of this rot.

  • Goodness me! It just gets more hilarious as you read on. I loved [acupuncture…] “will produce urination and defecation if the patient is alive. If otherwise, not.” This stuff can only have been invented by a bunch of pricks.

  • Does the benefit of acupuncture outweigh the risk?

  • It’s very interesting to observe how the alt-med community considers a 100 deaths or so a neglibile quantity while parts of that very same community continuously cite official reports stating a similar number of people claiming to have suffered some harm after a vaccination (putting the emphasis on claim), invariably claiming that these reports prove how harmful a given vaccine or vaccination in general is.
    Even leaving aside the fact that to my knowlegde a lot of these 100 or so deaths linked to acupuncture have been properly investigated and that those reports named the treatment as a certain or at least the most probable cause of death while most vaccine “cases” are just vaguely attributable to the vaccination at best (and official reports always say so) and few cases are ever deeply investigated on account of that fact, assuming, for argument’s sake, that both claims are equally probable, any way we look at it the only thing we see are the double standards the alt-med community use all the time: Bad, bad medicine and good alternative “medicine”, never mind the facts…

  • This is an important observation. We should watch patients who have been needled in the neck for symptoms and signs of vagus nerve injury. Acupuncturists are already trained to needle the neck carefully (superficially and at certain locations only), if at all, and we should maintain if not improve standards of training.

    But there is such a thing as “overdoing it”, and making a big deal about acupuncture being especially dangerous probably is. I’ve seen signs of an “acupuncture kills!” meme emerging among some skeptics, and it’s a good example of how to separate critical thinkers from the ones who aren’t.

    We know that a lot of acupuncture treatments have been happening every week for a very long time. This recent report of death due to vagus nerve injury is the first we’ve heard, and IIRC the first of any adverse event (lethal or otherwise) involving the vagus nerve. Besides that, we know of, what, five fatalities reported between 2000-2009? And then another 90, ever, in recorded history? And something like 0.5 serious adverse event in every 100,000 treatments. How many more can there really be? And are reporting and technique likely to get better or worse as they years go by?

    A study on MDMA found, or was interpreted as suggesting, something like this: One in ten mice might die after a certain level of exposure to MDMA. This aroused grave concern among some, to which one scientist responded by saying “many thousands of people take MDMA every week, and we know hundreds are not dying every week”. (It’s more like about one death a week, or about 1 in 100,000 “treatments”; cf. here.)

    That’s not a perfect analogy, but it highlights a kind of common sense. “Real acupuncture” may not do much good at all compared to “sham acupuncture” (fake needles and/or fake insertion and/or fake placement), and carries risks. So do a lot of things. About 22 deaths per year are reportedly caused by playing with teddy bears.

    We don’t know exactly how risky a lot of things are, but when it comes to some things that people have been doing for a long time to feel better — and then self-monitoring to see whether they feel better or not — we’re not exactly clueless. If taking MDMA or getting acupuncture were THAT risky, we’d know about it by now, because people would have become scared to do them. Just saying. Let’s keep our eyes open by all means (and specifically for signs of vagus nerve injury in patients who have been needled in the neck) but let’s not be so paranoid we start imagining unseen things lurking where they probably aren’t.

    • @sky saw,
      Your post is a very mixed bag, which, while trying to claim the moral and scientific high ground, does neither.
      ~
      “This is an important observation. We should watch patients who have been needled in the neck for symptoms and signs of vagus nerve injury. Acupuncturists are already trained to needle the neck carefully (superficially and at certain locations only), if at all, and we should maintain if not improve standards of training.”
      You start with the presumption that acupuncture is worthwhile and, if there is any risk subsequently recognised, training standards should be improved. What alt-meds fail to grasp is that the method of treatment first needs to establish itself as worthwhile before people are treated and the risk/benefit assessed. Offering a procedure where the skin is punctured without being aware of all of the risks or the training being inadequate hardly lends any credibility, more so when all of the available evidence shows it to be a mild placebo.
      ~
      “But there is such a thing as “overdoing it”, and making a big deal about acupuncture being especially dangerous probably is. I’ve seen signs of an “acupuncture kills!” meme emerging among some skeptics, and it’s a good example of how to separate critical thinkers from the ones who aren’t.”
      Self-evident logical fallacies, from someone claiming the position of “critical thinker”.
      ~
      “How many more can there really be?”
      A good question and who really knows, because acupuncturists don’t keep these sorts of records. Claiming a low incident rate from a position of ignorance is hardly credible either.
      ~
      Let’s keep our eyes open by all means”
      I have a suggestion for you; if you really want to keep your mind open to all of the evidence, stop practising a sham that has no evidence to support it. Read Edzard’s blog about the lack of evidence and come to the only ethical decision possible; stop practising! That is, of course, unless the financial considerations outweigh your pretense at ethics and morality?
      ~
      (The comparison with ecstasy is too absurd to even contemplate.)

    • @ sky saw: I would add a response to this …

      “We don’t know exactly how risky a lot of things are, but when it comes to some things that people have been doing for a long time to feel better — and then self-monitoring to see whether they feel better or not — we’re not exactly clueless.”

      Confirmation bias prevents most people from objectively “self-monitoring to see whether they feel better or not” after they buy into a particular treatment. It’s not that they’re clueless, it’s that they’ve acquired the belief that this remedy will make them healthier, even if that isn’t the reality. If they truly have a disease that needs treating, the placebo effect may help them “feel better” but the underlying cause may still be there. They’re not trained to detect and monitor it–and neither are acupuncturists and other alt-med providers, who just have their pre-scientific notions about the person’s condition.

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