On this blog, we have repeatedly discussed the risks of acupuncture. Contrary to what we often hear, there clearly is potential for harm. Acupuncture is, of course most popular in China where it has been used for thousands of years. Therefore the Chinese literature, which is not easy to access for non-Chinese speakers and therefore often disregarded by Western researchers, might hold treasures of valuable information on the subject. It follows that a thorough review of this information might be helpful. A recent paper by Chinese scientists has tackled this issue.

The objective of this review was to determine the frequency and severity of adverse complications and events in acupuncture treatment reported from 1980 to 2013 in China. All first-hand case reports of acupuncture-related complications and adverse events that could be identified in the scientific literature were reviewed and classified according to the type of complication and adverse event, circumstance of the event, and long-term patient outcome. The selected case reports were published between 1980 and 2013 in 3 databases. Relevant papers were collected and analyzed by 2 reviewers.

Over the 33 years, 182 incidents were identified in 133 relevant papers. Internal organ, tissue, or nerve injury is the main complications of acupuncture especially for pneumothorax and central nervous system injury. Adverse effects also included syncope, infections, hemorrhage, allergy, burn, aphonia, hysteria, cough, thirst, fever, somnolence, and broken needles.

The authors of this review concluded that qualifying training of acupuncturists should be systemized and the clinical acupuncture operations should be standardized in order to effectively prevent the occurrence of acupuncture accidents, enhance the influence of acupuncture, and further popularize acupuncture to the rest of the world.

This is a bizarrely disappointing article followed by a most strange conclusion. The authors totally fail to discuss the most important issue and they arrive at conclusions which, I think, make little sense.

The issue to discuss here is, of course, under-reporting. We know that under-reporting in the Western literature is already huge. For every complication reported there could easily be 10 or even 100 that go unreported. There is no monitoring system for adverse effects, and acupuncturists have no incentive to publish their mistakes. Accurate and realistic prevalence data are therefore anybody’s guess.

In China, under-reporting is likely to be one or two orders of magnitude bigger. I say this because close to zero % of all Chinese papers on acupuncture report negative findings. For China, TCM is a huge export business, and the interest in reporting adverse effects is close to zero.

Seen from this perspective, it seems at first glance laudable that the Chinese authors dared to address this thorny issue. In the text of the article, they even mention that the included complications resulted in a total of 25 fatalities! This seems courageous. But one only needs to read the full article to get a strong suspicion that the authors are either in denial about the real figures, or their paper is a deliberate attempt to ‘white-wash’ acupuncture from its potential to do harm.

In 2010, we published a very similar review of the Chinese literature (unsurprisingly, it was not cited by the authors of the new paper). At the time, we found almost 500 published cases of serious adverse events and stated that we suspect that underreporting of such events in the Chinese-language literature is much higher than in the English-language literature.

The truth is that nobody knows how frequent adverse events of acupuncture truly are in China – or most other countries, for that matter. I believe that, before we “further popularize acupuncture to the rest of the world”, it would be ethical and necessary to 1) state this fact openly and 2) do something about it.

4 Responses to Acupuncture risks: white-wash or denial?

  • Well, is this a case of having your cake and eating too, Ernst? Either acupuncture belongs to the superstitious nonsense that you rail about like a broken record, or it can have some effect. Which is it? 6 incidents per year is hardly startling, and while you are about it why don’t you compare equivalent interventions by doctors like injections, blood sampling, lumbar punctures and so on and see how the data compares.

    • interesting comment!!!
      it shows that you have understood next to nothing about risk and risk/benefit analyses.

      • I was merely comparing the use of needles. If you are interested in risk/benefit analysis then why don’t you do one? You never do the kind of comparisons that patients are trying to make all the time. Do a risk benefit analysis of say cortisone injections and acupuncture and see what you get. This is the problem with this blog where you seem unable to appreciate that patients are doing such a risk analysis in their own limited way and seeing that maybe there are unacceptable risks attached to orthodox approaches. Instead of trying to find out why people choose these therapies you simply patronise them in the worst possible way. They are trying to be rational rather than employing superstition which the gallery that you play to like to crow over. I hope there are only a few doctors in that gallery because the lack of generosity in the posts I have read is breathtaking for people supposedly in health care. None of the posters here have actually any idea what drives people to alternative remedies and this blog contributes nothing to understanding those reasons.

        • “Do a risk benefit analysis of say cortisone injections and acupuncture and see what you get.”
          “None of the posters here have actually any idea what drives people to alternative remedies and this blog contributes nothing to understanding those reasons.”
          HOW DO YOU KNOW?

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