MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

As if to celebrate the end of ‘Acupuncture Awareness Week’, I am off today to give a few lectures in Oslo. One title is most fitting: ACUPUNCTURE: FACTS AND FALLACIES. Here are some of the fallacies I intend to discuss:

  • Appeal to popularity
  • Appeal to tradition
  • Science can explain how it works
  • Acupuncture is a ‘cure-all’
  • It worked for me, my aunt, etc.
  • Acupuncture even works for animals
  • Even if it’s just a placebo, it helps patients.
  • It defies scientific testing.
  • Acupuncture research is productive
  • Acupuncture is by definition rubbish
  • Acupuncture is risk-free
  • Its benefits outweigh its risks

None of these themes need much by way of explanation for the readers of this blog, I think.

So, why do I mention them at all?

The answer is simple: I was hoping to get a few inspirations and tips from you for further subjects that I might include.

WHAT DO YOU THINK ARE THE MAIN FALLACIES IN THE REALM OF ACUPUNCTURE?

64 Responses to Acupuncture: what are the main fallacies?

  • Science can explain how acupuncture works: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2644274
    In fact, science can not only explain but also predict the results of both basic and clinical acupuncture – meeting the gold standard of science.

    • @Charles Shang.

      In that linked paper you wrote “Current acupuncture research suggests a convergence of the neurophysiology model, the connective tissue model and the growth control model. The growth control model of acupuncture set the first example of a biological model in integrative medicine with significant prediction power.” Too bad the prediction power doesn’t extend to explaining why acupuncture does nothing beyond placebo in well designed clinical trials!

      • Please look up Cochrane Reviews – the gold standard of evidence based medicine, which confirmed that acupuncture is better than placebo in treating nausea, vomiting, induction of labor, dysphagia after stroke, breech presentation, as well as various pain syndromes. The model http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2644274 predicted that there is negative correlation between the number of acupoints used and the effect size. This has been confirmed by Cochrane Reviews.
        There are a bunch of incompetent researchers who used too many acupoints which wash out the difference between real acupuncture and placebo. Any acupuncture RCT which uses more than 5 acupoints is likely trash until proven otherwise. If you discard those trash, there is clear difference between real acupuncture and placebo in treating many disorders.

        • @Charles Shang

          Cochrane Reviews. Fine. Haven’t checked back on acupuncture since David Colquhoun wrote the most scientifically convincing verdict on the subject: Acupuncture is a theatrical placebo.

          So I went to the Cochrane website. Here are the authors’ conclusions from the first six publications that showed up. Sorry not to do more, but it’s all been done many times before, including in this blog, this week. I have a life to live.

          Acupuncture for treating fibromyalgia. Deare et al., 2013, DOI: 10.1002/14651858.CD007070.pub2
          Authors’ conclusion: “There is low to moderate-level evidence that compared with no treatment and standard therapy, acupuncture improves pain and stiffness in people with fibromyalgia. There is moderate-level evidence that the effect of acupuncture does not differ from sham acupuncture in reducing pain or fatigue, or improving sleep or global well-being. EA is probably better than MA for pain and stiffness reduction and improvement of global well-being, sleep and fatigue.” There was no high-quality evidence.

          Acupuncture for insomnia. Cheuk et al., 2012, DOI: 10.1002/14651858.CD005472.pub3
          Authors’ conclusion: “Due to poor methodological quality, high levels of heterogeneity and publication bias, the current evidence is not sufficiently rigorous to support or refute acupuncture for treating insomnia.”

          Acupuncture for depression. Smith et al., 2010, DOI: 10.1002/14651858.CD004046.pub3.
          Authors’ conclusion: “We found insufficient evidence to recommend the use of acupuncture for people with depression. The results are limited by the high risk of bias in the majority of trials meeting inclusion criteria.”

          Acupuncture for tension-type headache. Linde et al., 2008, DOI: 10.1002/14651858.CD007587.
          Authors’ conclusion: “In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.”

          Acupuncture for dysmenorrhoea. Smith et al., 2010, DOI: 10.1002/14651858.CD007854.pub2.
          Authors’ conclusion: “Acupuncture may reduce period pain, however there is a need for further well-designed randomised controlled trials.”

          Acupuncture for autism spectrum disorders (ASD). Cheuk et al., 2011, DOI: 10.1002/14651858.CD007849.pub2
          Authors’ conclusion: “Current evidence does not support the use of acupuncture for treatment of ASD. There is no conclusive evidence that acupuncture is effective for treatment of ASD in children and no RCTs have been carried out with adults.”.

          If you think this Cochrane evidence — just one of six sets of authors with an unqualified positive conclusion — suggests that acupuncture is seriously effective in anywhere near a convincing manner, your own gold standards for evidence are way more relaxed than mine. The absence of high-quality studies speaks for itself.

          • It apparent like that you do not have much real experience in medical research and medical practice. For vast majority of treament used in conventional medicine, the evidence is low to moderate level. We already have about 1 dozen Cochrane reviews showing moderate level of positive evidence for acupuncture and the number has growing steadily in the past decades, that is fairly convincing – much stronger evidence than the supporting evidence for angioplasty and most of the conventional drugs on the market.

          • Most of the reviews you listed are based on trash RCTs as I pointed out earlier – more than 5 acupoints were used. The negative conclusions are likely trash. Look at the RCTs using fewer than 5 acupoints – the difference between treatment and placebo is usually obvious.

          • By the way, David Colquhoun’s article is just a piece of trash – he should have read Cochrane Reviews and other evidence more carefully.

          • @Charles Strang

            I am not short of experience with medical research or medical practice, but we’ll let that ride. You are making a claim concerning RCTs involving fewer than 5 acupoints. I don’t have the time or impetus to trawl through Cochrane Reviews to pick out those papers. With your expertise, interest and commitment, you should do the job and dispassionately document the evidence for your own claim. If the evidence is already there, please point us to the reference.

          • Regarding the negative correlation between the number of acupoints used in RCTs and effect sizes, the preliminary report was published http://spie.org/Publications/Proceedings/Paper/10.1117/12.2185052. I am writing up a comprehensive analysis now.

          • @ Charles Shang

            Ever heard the term “Tooth fairy science”?

            It refers to doing research on a phenomenon before it has been scientifically established that the phenomenon exists. Dr. Harriet Hall, who coined this term, put it this way:

            You could measure how much money the Tooth Fairy leaves under the pillow, whether she leaves more cash for the first or last tooth, whether the payoff is greater if you leave the tooth in a plastic baggie versus wrapped in Kleenex. You can get all kinds of good data that is reproducible and statistically significant. Yes, you have learned something. But you haven’t learned what you think you’ve learned, because you haven’t bothered to establish whether the Tooth Fairy really exists.

            Acupuncture has not been scientifically established to do anything in or to the body other than produce small traumatic wounds and the normal, expected reactions to them. If they worked, slapping the cheek would also work.
            It is no use doing more “research” or other scientific somersaults on acupuncture. All such exercises will of course inevitably produce some kind of result but the result, be it in favour of the hypothesis or not, will be meaningless.

          • Have you heard of Cochrane Reviews? Do you know what is the gold standard of evidence based medicine? If you have, please look up acupuncture in Cochrane Reviews, especially what I mentioned regarding nausea, vomiting, labor, breech presentation etc. . If you have not, please do not waste our time.

          • @Charles Shang

            Your link takes us to the abstract. The paper sits behind a paywall.

          • @ Charles Shang
            What are you talking about?
            A search for acupuncture on Cochrane produces 109 items. I cannot find any that show acupuncture to be useful for anything. There is the normal random “noise” of course but the overall picture is consistently negative. Perhaps you could go through them and tabulate which ones show that acupuncture works? I don’t have the time, patients waiting.

        • @Charles Shang
          The next patient was delayed so I had a look at some of the items you mention above, as being proven effects of acupuncture. The correction of breech presentation is something I have an interest in for several reasons, one being that the wife is an obstetrician.
          “Acupuncture” and “breech presentation” turn up a small collection of hits on PubMed. Most of it is about moxibustion discussion and comments but there was one review that seemed interesting until someone literally ‘slaughtered’ this incompetently performed review:

          http://www.sciencedirect.com/science/article/pii/S0965229908000654

          Acupuncture (or its derivatives, like moxibustion) are useless for breech presentation and there is no sensible mechanism by which it could work.
          Why do you keep on believing this nonsense? It is easy to find out, if you know how to search and read scientific material. Is that the problem perhaps?

          • Just catching catching up and noticed the post with the horrific idea that acupuncture could help in breech presentation. Perhaps this helps to explain the low life expectancy in China in the past and the correlation between its increase currently and decreased use of acupuncture.

          • You should read Cochrane Reviews again: Effect size of 2.04 is not negative for correcting breech presentation.
            Effect size of 1.06 is not negative for reducing length of labor. Effect size of 3.52 is not negative for relieving acute low back pain. Consider keeping the trash citation to yourself if you are not willing to face the high level evidence. By the way, this is the last time I am replying to you as you are not truly interested in evidence. If you do not understand the mechanism, read http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2644274

          • @Charles Shang

            It would help if you took some deep breaths before replying, there is a hint of frustration in your responses.
            You maintain that there is scientific evidence for the mechanism of action of acupuncture and in what seems to be support for this assertion, you paste for the third or fourth time a reference to your own single author, highly speculative essay on what looks like your favoured hypothesis, published in a journal that is known to publish anything as long as it sounds alternative.
            Perhaps one day you will convince us Charles, with scientifically sound, ground braking evidence in the form of corroborated, credible research findings and we will surely applaud you on your Nobel-prize level achievement. But until then… your speculations should be taken at face value.

            Cochrane
            You insistently claim that Cochrane collaboration reviews is the gold standard in medical evidence. Be that as it may but Cochrane reviews are generally of quite varying quality and have, like any other such work, to be read with a critical mind. Even gold standards can be wanting and many of the authors are themselves severely biased in favour of their speciality.
            
You give several numbers of “effect sizes” but fail to give the references to your sources. This would help greatly and is expected in this forum.

            It so happens that I am very interested in evidence for the use of acupuncture in pregnancy an labour. So let’s put the other items you mention aside and spend some effort on these matters, which I have been asked to look into as they are being increasingly applied by midwives in my part of the world along with aromatherapy and some other unproven alternative ministrations. The worry is that these exercises are interfering with normal pregnancy and labour without being of much or even any use.

            There is a lot to consider regarding any kind of treatment attempts in pregnancy and labour, such as the gestational period of intervention, the base rate of normal/spontaneous correction of malpresentation, the use of other methods simultaneously to the use of acupuncture, etc. And there is also the very important question of ethics. It is rather questionable to perform studies on a method totally lacking in a credible physiological mechanism of action, which may interfere or delay proper obstetric care. This is one of the main objections many have to the use of acupuncture and other unproven alternative methods in obstetrics.

            But let’s not digress too far.

            You said yourself for example that Cochrane reviews…:

            …confirmed that acupuncture is better than placebo in …induction of labor, … breech presentation,…

            I have institutional access to the entire Cochrane library and I am usually quite clever when it comes to searching in databases and for information in general.
But I find only one finished review on breech presentation and acupuncture, or rather on a variation on the method. A completedreview that concludes: “Moxibustion was not found to reduce the number of non-cephalic presentations at birth compared with no treatment”
            As the authors were obviously enthusiastic about finding support for their favored subject, there is quite some speculation around other endpoints, such as the use of oxytocin and combinations with other methods. All these a-posteriori/secondary endpoints are invalid for obvious reasons such as lack of blinding and control.
            So, moxibustion is confirmed useless by a Gold standard (to use your words) Cochrane review. In the light of no confirmed or even likely mechanism of action that fits with the known function of the human body, this is not unexpected.

            I find one more item, which is only a protocol for a review:
”Acupuncture for turning a breech baby in pregnancy”. The authors are: Shao C Lee1, Gillian ML Gyte and Lixia Dou
            It is from 2012 and I can find no review or even preliminary results after almost four years.

            The protocol itself is regrettably behind a paywall. It makes a very interesting albeit worrying reading.
Up front in the protocol the authors declare their distrust in the mainstay of evidence, the placebo controlled trial and go on at length to ratify their disbelief with wordy elaborations. I am afraid this may heavily affect the authors neutrality and thereby the credibility of their eventual product. Their protocol clearly indicates that the authors will likely be rather unhappy should the review not confirm their expectations.

            And to conclude the subject we started on, let’s see what the gold standard review says about acupuncture for induction of labour: 
“There is insufficient evidence describing the efficacy of acupuncture to induce labour.”
            
Now where did you find your ‘alternative’ result Charles? In an alternative Cochrane library??

  • An important fallacy which abounds in the realm of ‘Acupuncture’ is failure to distinguish between:
    (i) The undoubted benefits of patients being in a constructive therapeutic relationship with an empathic practitioner. (Many patients probably do ‘feel better’ after a session. Much depends on their response expectancies).
    And: (ii) The effects of small needles placed in the skin generating/liberating/unblocking ‘energies’ of undetermined nature which nevertheless have a recognisable effect on pathological processes.

    By conflating these two quite sepatate effects and simply referrring to ‘acupuncture’, it is has not been possible to distinguish placebo (or context) effects from those which might possibly result from genuine stimulus of yin/yang, meridians/points etc. With no plausible evidence for any of these concepts, acupuncturists have to mislead patients.

    So, another important fallacy is that many (Most? No?) acupuncturists fail to obtain fully informed consent from patients.
    And that is unethical.

  • Well, Even if I just finished a triple Cappuccino at a cafe in Oslo, I cannot think of important items to add to your list. But in my mind, the biggest fallacy in this context is the one of history. The appeal to tradition fails in many points because history contradicts them. My favourite “go-to” evidence, apart from the writings of people like Ben Kavoussi and Paul Unschuld who have studied the real[sic] history of chinese medicine, is the readily available online book I have so often linked to here in this blog:
    “Thirty years in Moukden, 1883-1913, being the experiences and recollections of Dugald Christie.” The whole book is interesting reading, giving a first hand insight into life and times in Manchuria at a tumultuous period.
    But his chapter five, on Medical practice among the Chinese is so near to irrefutible evidence as can be found, that acu-puncture shortly before its reinvention during the twentieth century, was nothing but a philosophy based bood letting torture and mayhem.

    I thought about delaying my flight out of Oslo so I could meet up with you, but I really need to go home and tend to matters domestic. So I’ll have to find another opportunity to raise a glass with you. Now, off to the airport…

    • If I were you, I’d avoid bringing up Unshuld. This is from the first part of a 2 part interview:

      http://www.acupuncturetoday.com/archives2004/jul/07bauerunschuld.html

      “Nevertheless, while they (current literature on Chinese Med) reflect Western yearnings, they fail to reflect the historical truth of Chinese medicine. Chinese medical history is, indeed, a huge treasure box, and given that TCM has selected only parts of its contents, serious historical research may turn up many more.”

      “Anybody who is interested in knowing the true historical origins of Chinese medicine should read this introductory volume to the Huang Di Nei Jing Su Wen project. It is only with this background in mind that one is able to reach an informed judgment on what early Chinese medicine may contribute to our health care needs today.”

      And, from part 2: http://www.acupuncturetoday.com/mpacms/at/article.php?id=28498

      “Acupuncture, it appears, at no time played a dominant role in Chinese health care. No reliable history of acupuncture is available in Western languages or Chinese.”

      (It seems that Unshuld disagrees with you about Christie’s chapter five being irrefutible evidence…)

      • “Acupuncture, it appears, at no time played a dominant role in Chinese health care. No reliable history of acupuncture is available in Western languages or Chinese.”

        Yes, because it always was, and still is, abject nonsense that doesn’t cure any known disease. The fact that it plays a role in western 21st Century health care is far beyond laughable, it is utterly despicable.

        • Pete

          Can you be more specific on what you mean by ‘abject nonsense’? (Hopefully, it’s nothing related to the earlier Harriet Hall link you posted – her interpretation is definitely abject nonsense.)

          And, more from the Unschuld (one of Bjorn’s go to favorites) interview,

          “Thus, acupuncture in its beginnings was meant as a tool to correct early physiological deviations from a correct course of events, not to treat manifest disease. Dietetics was recommended for the same purpose. In contrast, the materia medica tradition of health care acknowledged, in true Daoist and Buddhist fashion, the unavoidability of disease. Thus, the pharmaceutical approach emphasized both prevention and therapy. However, in the course of time, acupuncture proved to cure numerous ailments. Hence, physicians drew their own conclusions and used needle therapy to treat a wide range of illnesses. Nevertheless, from the 17th century on, acupuncture lost much appeal in Chinese society, in the same way as heroic pharmaceutical therapies were no longer applied by most Chinese physicians. Tuina massage instead of acupuncture, and “harmonizing” rather than “attacking” pharmaceutical recipes, became the new ideals of Chinese health care.”

          At one point, you could access Unschuld’s Huang Di Nei Jing Su Wen online. You should have a look, it might still be out there. (the book itself is quite spendy)

          • Jm, You said Harriet Hall’s interpretation is abject nonsense. It is the interpretation used by most acupuncturists in the West because it follows the basic tenets of TCM. Two quotes from the British Acupuncture Council website:
            “Treatment involves the insertion of very fine needles into specific points on the body to affect the flow of your body’s qi, or vital energy.”

            “It is based on a theory of energy, called ‘qi’ (pronounced ‘chee’) and its balance and flow throughout the body. To put it very simplistically, pain and discomfort only arise where the flow is blocked, or where there is a deficiency or an excess in one of the well-defined pathways, called meridians, where the energy flows.”

            Perhaps you will provide us with a 21st Century science-based theory of acupuncture that relies on evidence rather than on appeals to ancient tradition, vitalism, etc. There are some excellent scientific explanations for the observed effects of various CAM modalities and why the sham versions produce similar (and sometimes better) results. It will be interesting to see how well your source(s) of explanation matches the latter.

          • Pete

            If you go to the British Sunset Council’s page, you could find the time of today’s sunset. If you don’t put in the effort to figure out what they mean by ‘sunset’ you might come to the conclusion that they think the earth is stationary and the sun moves around it.

            The British Acupuncture Council site gives a bit more explanation than what you quoted, and I’m sure they are aware that they are providing a very brief, superficial overview. Harris uses a mutated version of a brief explanation, and uses it to support “Applying Rigorous Science”. That would be abject nonsense.

            When you say “because it always was, and still is, abject nonsense”, what exactly do you mean?

          • @jm

            You said to Pete: “The British Acupuncture Council site gives a bit more explanation than what you quoted”.

            From the British Acupuncture Council website: “Acupuncturists insert very fine needles at precisely located points to connect with your body’s qi. They will decide which points are right for you after a detailed consultation covering every aspect of your health and lifestyle. The aim is to direct the flow of qi to trigger your body’s healing response and to restore physical, emotional and mental equilibrium. Treatment is designed to affect your whole being as well as your symptoms so, as the condition being treated improves, you may notice other health problems resolve and an increased feeling of wellbeing.”

            That reads like less mechanistic explanation to me. The problem here is the complete absence of any definition of ‘qi’, ‘energy flow’ and ‘body’s healing response’ that is not gobbledygook. Through the process of science we have learned over the past 2000 years or so what makes the body tick. To reject all that knowledge and evidence in favour of supernatural, superstitious claptrap is bizarre, to put it mildly.

            By the way, ‘sunset’ is a well defined, fully understood term with screeds of mechanistic explanation of all aspects. ‘Qi’ remains mystical hand-waving.

          • “‘Qi’ remains mystical hand-waving.”

            Only if you don’t put in the effort to understand the term. Until you put in some effort, you’ll just have to be comfortable with gobbledygook. We’ve had this discussion.

            Unschuld seems to be some common ground here – read his introductory chapter to the Huang Di Nei Jing Su Wen, he talks about the term qi and its usage. I won’t type in the whole section – but it includes “It should be noted that the interpretation of qi 氣 as “energy”, so widespread in TCM literature today, lacks any historical basis.”

            Coming to the superstitious claptrap conclusion without understanding the term is utterly bizarre, to put it mildly.

          • Jm, I don’t own the burden of proof that acupuncture is firstly, medically efficacious beyond placebo; and secondly, that it has a plausible hypothesis for its efficacy that convincingly rejects its null hypothesis *and its alternative hypotheses*. Alternative hypotheses for the observed effects of CAM modalities, that are based in science, are the complete opposite of abject nonsense.

            ‘Acupuncture Awareness Week’ has made me aware of its risks and of its long history of abject nonsense. A few other examples of abject nonsense are: applied kinesiology, astrology, bloodletting, chiropractic subluxations, faith healing, homeopathy, iridology, Reiki, and especially remote/distant Reiki. If the tenets of any one of these things were true then it would render the others false. This is why the CAM empire never uses the scientific method to test its many branches against each other. Such testing is essential in medicine [and most/all branches of applied science] because this is the only method that enables it to progress by reducing the risks and/or increasing the benefits. Just imagine what would happen if remote/distant Reiki was found to outperform all the other modalities. It has [one of] the the lowest risks because it doesn’t require journeys to be made by either the practitioner or the patient.

            Health practitioners are required to obtain informed consent from their patients, but this is impossible in the CAM industry because it refuses to conduct the research that is required to provide this essential information. An acupuncturist is not going to tell a patient on their first visit something along the lines of: For your particular symptoms, the evidence shows that you should first see a Reiki practitioner; if that doesn’t work, see a homeopath; if that doesn’t work, see a chiropractor; if none of them work, come back to me and we’ll try acupuncture; if that doesn’t work, see a nutritionists… No, it is the first CAM practitioner we visit whom will be the one who starts emptying our wallet. This isn’t medicine in any way, shape, or form; it is the precise definition of quackery.

            Quack [noun]: a person who dishonestly claims to have special knowledge and skill in some field, typically medicine. [Obviously, this means established 21st Century evidence-based medicine, not a branch of CAM because CAM that actually works is called medicine, not alternative medicine.]

            BTW, Jm, in order to recommend medical treatments one has to be qualified in, and licensed to practise, medicine. Practitioners who meet these criteria never recommend a treatment modality to anyone BEFORE DIAGNOSING THE PATIENT. Your relentless apologetics for acupuncture, TCM, and other CAM modalities is demonstrating only that adherents of CAM cling ever more tightly to their belief system when asked to provide evidence. This is precisely why CAM qualifies as a religion: a belief system that not just lacks verifiable empirical evidence; it refuses to abandon its doctrines in the light of new evidence. “Faith is pretending to know things you don’t know.” — Dr Peter Boghossian.

            Qi, meridians, vital energy, etc. etc. don’t exist anywhere [they don’t simply lack evidence, they have been scientifically discredited] other than in the idle meandering thoughts of pre-scientific philosophers, alchemists, and astrologers who were (and those who still are) totally clueless about modern: biology; germ theory; the structure of matter; cognitive neuroscience; cosmology; critical thinking skills; and the scientific method. Emulating them isn’t cool, even though it remains currently lucrative to do so. You are entitled to hold your beliefs in private, but you are not entitled to espouse them as facts to vulnerable members of the public, especially not to those who are suffering chronic physiological and/or psychological health problems.

          • Pete

            I’m not asking you to own burden of proof – I was simply hoping that you had looked into things like yin/yang, five phase, etc and could give me specific reasons why you disagree with them.

            I’m sorry you have the “relentless apologetics for acupuncture” view. Until recently, I assumed that comments that mention mystical energy, etc were being facetious – I didn’t think that anyone in this day and age would seriously think that acupuncture was based on sticking needles into magical points to influence magical energy and all that. When you say “long history of abject nonsense” I was hoping you dug deeper than current descriptions. Current descriptions don’t have a long history.

          • http://skepdic.com/yinyang.html
            QUOTE:
            “The established laws of nature do not support Oriental Medicine’s claim of Yin and Yang and Five-Phases Theory. Oriental Medicine’s main theory was constructed when our civilization had limited methods to understand our surroundings, and as such, it is only an ancient illusion.” — Yong-Sang Yoo, MD, PhD, Chairman of the Committee for Medical Unification, Korean Medical Association, 2010

            “….responsible physicians, scientists, and public health officials in the West should follow the momentum created by Yong Sang Yoo and Zhang Gongyao in Asia, and call for an end to the licensing of Oriental Medicine practitioners. The modalities and the rationale used by these practitioners are almost identical to the ones we abandoned centuries ago. As George Ulett, MD, PhD, wrote in 2003, it is a ‘travesty that in this time of scientific evidence-based medicine, treatments based on archaic thinking are given to unsuspecting patients.'” — Ben Kavoussi, Oriental Medicine: a Tall Tale of Outdated Lore, 2012.

          • Pete

            Skepdic.com’s interpretation of yin yang theory doesn’t match with historical definitions, understandings, or applications. Or modern ones, either. You need a better source – in addition to Unschuld, there are many others.

          • Jm, I knew your answer would be an attempt to discredit the Skeptic’s Dictionary rather than the source of the information — Yong-Sang Yoo, MD, PhD, Chairman of the Committee for Medical Unification, Korean Medical Association — and Ben Kavoussi’s article which starts with the same quote.

            Who do you think I should listen to for medical advice/information regarding Oriental Medicine out of the following people: Yong-Sang Yoo, MD, PhD; Professor Dame Sally Davies, DBE, FMedSci, FRS, Chief Medical Officer for England; Paul Ulrich Unschuld; and jm.

            Without using any modern scientific words and theories, using only pre-scientific metaphysical concepts, such as qi and yin yang theory, explain how the following work: a gas turbine engine; a television system; the Internet; the Hubble Space Telescope; the human body. Then explain how to repair each of them when they develop a fault.

            The above exercise will enable you to quickly realize who is, and who isn’t, talking abject nonsense. My point is that, however you define ancient metaphysical concepts, they do not have sufficient alignment with reality, explanatory power, and explanatory depth for 20th and 21st Century science, let alone for 21st Century medicine.

          • Pete
            I wouldn’t listen to any of the folks you mentioned regarding medical advice regarding Chinese medicine. None of them are practitioners, including me.

            The quote that skepdic pulled from Yoo, – “The established laws of nature do not support Oriental Medicine’s claim of Yin and Yang…” It’s pretty universally agreed upon that in a broad sense, yin yang theory is about change. Everything changes and transforms. Maybe the established laws of nature don’t support that? I have no idea. You say that science has disproven that idea, please elaborate.

            In a practical sense, yin and yang are used to describe how a part relates to the whole, or to another part. They are not absolute terms, but characteristics of yin are generally considered dark, night, cold, receptive, retreating, inside, empty, less…things like that. Yang characteristics are generally considered light, day, hot, expanding, full, more…things like that. But it’s all relative to whatever reference point you want to choose.

            The outside of the body is considered yang, inside yin. A hypertonic muscle yang, an atrophied muscle yin (compared to its normal state). A flexed arm, yin. Extended arm, yang. Blood, yin. Moving blood, yang. Blood pressure higher than a normal – yang. Lower than normal – yin.

            You say this has been disproven? They are labels, to describe how things relate to each other. Or where they’re at in the process of change.

            Here’s how yin yang theory would be used in relation to the following:
            A gas turbine engine – off, yin. On, yang. Same with a television system. The internet, yang, an intranet, yin. The Hubble Space Telescope, yang. My binoculars, yin. The human body…yin compared to a mountain. Yang compared to a mole hill.

            How to repair each of them when they develop a fault? That’s not what that theory is for. Claiming it is, is abject nonsense.

            But then again…anyone who has had to repair anything knows the most important universal truth. First thing you do is turn it off (yin) then back on again (yang) – and see if that solved the issue.

          • No use argumenting with “jm” the Gua Sha performer, whose worldview is quite simplistic:

            But then again…anyone who has had to repair anything knows the most important universal truth. First thing you do is turn it off (yin) then back on again (yang) – and see if that solved the issue.

            I guess that’s the idea behind Gua Sha, cupping, acupuncture, bloodletting, etc… First you harm the patient* (yin) while you elaborate on how wonderful and effective the treatment is and hope the problem fixes itself (Yang).

            *Apparently there were cultures where someone was actually “turned off” i.e. sacrificed (Yin) to see if the problem at hand would go away (Yang).

          • jm,

            “Here’s how yin yang theory would be used in relation to the following:
            A gas turbine engine – off, yin. On, yang. Same with a television system. The internet, yang, an intranet, yin. The Hubble Space Telescope, yang. My binoculars, yin. The human body…yin compared to a mountain. Yang compared to a mole hill. ”

            In what world of distorted, confused, insane intellectual fantasy does this constitute a theory (hypothesis or explanatory framework)?! Obviously I can refer to my TV as yin or yang, rather than off or on, if I wish to emphasize my affection for things Chinese, but in what lunatic world can this be interpreted as knowledge with the potential for explanation?

            How does yin and yang explain the difference between PAL and NTC systems? Between plasma, LCD and LED displays? In the latter case the difference between PMOLED and AMOLED displays? Which of the channels I watch are yin and which yang (and why)?

            I am yin compared to a mountain and yang compared to a molehill. Wow: deep profundity! Why do I need these words to label the bleeding obvious? ‘Bigger’ and ‘smaller’ do the job perfectly well, with the added advantage that I can quantify how much bigger or smaller when comparing two things, in the detailed terms of length, breadth, height, volume, mass and even subjective perception.

            If you wish to argue you can’t disprove a mere label, that’s one thing. To suggest these two binary excuses for deep thought provide a workable system for worthwhile study of anything, from medicine to airliners, is to reveal a mindset devoid of any sense of the real world, any concept of real knowledge, any hope of providing something of genuine value to other people. To promote yin, yang and, for that matter, your other favourite, ‘qi’, in the 21st century, indicates a brain that has been pushed through a scrambler.

            Trust me: it takes NO effort to understand these words (you have previously accused me of not making the effort). They are meaningless, obsolete, outmoded, fossilized, moth-eaten concepts that, by now, should be extinct.

          • Frank

            “Trust me: it takes NO effort to understand these words (you have previously accused me of not making the effort).”

            Rather than trust you, why don’t you just explain the meanings of qi and yin yang, and how they are used in Chinese medicine.

      • “Jm” has an uncanny ability to misread something into texts that adapts their meaning to suit his/her oriental fantasies. And unable even to spell the key names (s)he is trying to misquote.

        • Oh, here’s your missing “c” Bjorn. Sorry that was so confusing. But, Unschuld’s interview, and the intro to the Su Wen, are pretty straightforward. I’m kind of surprised that you of all people include him as your favorite ‘go to evidence’ – I think you’re missing his points.

        • Of course “jm” is surprised.
          Cannot understand the difference between historical accounts and interpretations of prescientific fantasy on one hand and science and reality on the other.
          Or rather, “jm” doesn’t want to understand it because apostasis would mean a painful loss of face and income from the lucrative skin scraping business. Hard to carry on scraping people if you don’t believe in some mystical effect from it.
          I wonder if “jm” has decided whether “Qi” is electromagnetism or pneumatic pressure? There seemed to be quite some confusion in “jm”‘s mind back in the Gua Sha thread.

        • I actually do understand the difference between historical accounts and translations of classics. I’ve been continually surprised that you bring up Christie. At the beginning of the book, he tells you it’s anecdote (“This only attempts do deal with personal impressions…) and incomplete (”It does not attempt to give a complete account of Manchuria, nor even of Moukden, nor to depict minutely its people and their customs.) And his main point for being in China in the first place was to spread Christianity (being a missionary) which I believe you have referred to as fairy tale. So yes, I am surprised that you plug a book of anecdotes written by a fairy tale peddler, and refer to it as “so near to irrefutible evidence as can be found”.

          And also surprised that you consider Unschuld a “go to favorite”. His translations are considered the gold standard, and include needling methods you have repeatedly claimed didn’t exist until the modern age. For example.

          But mainly I’m surprised that you seem to disagree with his observation that:

          “Anybody who is interested in knowing the true historical origins of Chinese medicine should read this introductory volume to the Huang Di Nei Jing Su Wen project. It is only with this background in mind that one is able to reach an informed judgment on what early Chinese medicine may contribute to our health care needs today.”

          So yes, consider me surprised.

          • So “jm” thinks that the God-fearing surgeon and missionary’s proclamations of modesty annul his credibility and therefore we should ignore his medical expertise and first hand observations of what he saw and experienced in China during thirty years?
            It seems like “jm” thinks we are as stupid as (s)he.

            As any quack, “jm” is blind to anything not fitting his financially lucrative fantasy.
            He reads translations of ancient “medical” magic and historian’s comments on them like the Devil reads the Bible.

          • I’m not saying you should ignore that at all. I’m curious – if you disagree with Unschuld’s translation, his opionion that you should have an informed historical understanding of Chinese med to have an informed opinion, etc…why is he one of your go to favorites?

          • Paul Unschuld is an expert in Chinese medical history and of course extremely interested in its deeper history and the philosophy behind its ideas and believes. He may at first glance sound like he believes that “chinese medicine” works but I seriously doubt it. Whether he does or not is beside the point as I will explain. There is a quote from Unschuld, that quacks repeatedly refer to as proof that he says TCM works. It was in an interview in an acupuncturists webzine where he said (or is quoted as saying):

            However, in the course of time, acupuncture proved to cure numerous ailments.

            Taken out of context these words may sound as he interprets history as saying it was proven to work but if you read the whole interview, it becomes clear that he is only referring to an historical interpretation of what was the current belief back then.
            Previously in the same interview he says:

            …few people are aware that TCM is a misnomer for an artificial system of health care ideas and practices generated between 1950 and 1975 by committees in the People’s Republic of China, with the aim of restructuring the vast and heterogenous heritage of Chinese traditional medicine in such a way that it fitted the principles – Marxist-Maoist type democracy and modern science and technology – on which the future of the PRC was to be built. TCM, as it came to be known in the West beginning with the late 1970s, reflects only a portion of the tremendously variegated body of knowledge accumulated in the preceding two millennia. While it is entirely understandable and legitimate for the Chinese leadership to select from this tradition, and to reinterpret those elements it considers helpful to build a future meaningful coexistence of modern Western and traditional Chinese ideas and practices, it is not clear whether populations in Western countries wish to make the same choices when they are confronted with the legacy of the past. It is therefore that I distinguish between TCM and “CTM,” the latter referring to the entirety of health care knowledge, beliefs and practices prior to the 20th century.

            Of course, ardent believers may read this as the Devil reads the Bible but the meaning is clear, Chinese medicine post-Mao is not the same as was practiced before and has nothing to do with reality or ages of experience.
            I have a strong suspicion that the acupuncturists who run this webzine redacted the above mentioned interview to fit their fancy because in another interview in the German magazine “Der Spiegel”, Unschuld virtually decapitates (modern) TCM in very clear words.
            I do not have time now to translate the text of the interview and I am not the best at German so perhaps Edzard or someone else might do a translation for us?
            Google Chrome can do a helpful translation if you know how to decipher the different way Germans put together sentences.
            The title of the interview says it all:
            “Oriental healing arts have very little to do with Chinese tradition”
            (By Oriental healing arts they mean the new/modern invention from the seventies.)

            In this interview among other interesting revelations, Unschuld says there was no one version of Chinese traditional medicine but thousands and that acupuncture was rather unpopular.
            He also tells how the trouble really began with “Qi” being redefined by George Soulié de Morant, the frenchman who is considered to have invented TCM acupuncture, from “nutritional steam” that travelled along with the blood to some mystical energy.

            I do hope someone is willing to translate this very interesting interview from Der Spiegel.

          • “He may at first glance sound like he believes that “chinese medicine” works but I seriously doubt it.”
            I think you can put your doubts to rest. I’m pretty sure he doesn’t. Personally, I think that makes his translations and explanations more valuable.

            “However, in the course of time, acupuncture proved to cure numerous ailments.”
            Here’s a bit of context:
            “Hence, physicians drew their own conclusions and used needle therapy to treat a wide range of illnesses. Nevertheless, from the 17th century on, acupuncture lost much appeal in Chinese society, in the same way as heroic pharmaceutical therapies were no longer applied by most Chinese physicians. Tuina massage instead of acupuncture, and “harmonizing” rather than “attacking” pharmaceutical recipes, became the new ideals of Chinese health care.”
            Better would be to read the whole interview.

            “I have a strong suspicion that the acupuncturists who run this webzine redacted the above mentioned interview to fit their fancy…”
            You should have asked Matthew Bauer when you were talking to him on a previous thread. That would have been interesting. I’m sure you can email him.

            “Chinese medicine post-Mao is not the same as was practiced before…”
            I think everyone agrees on that…

            “Unschuld says there was no one version of Chinese traditional medicine but thousands and that acupuncture was rather unpopular.”
            In the Su Wen intro, he goes deeper into that – and explains why. You should read it.

          • I wonder if “jm” is cognitively aware of how her/his quackery-muddled mind subliminally ignores the uncomfortable parts, e.g. the Der Spiegel interview where PU speaks in no uncertain terms and how he consistently builds strawmen on his opposition like when (s)he says I pulled a sentence out of context when I clearly gave a reference to the full text, which BTW does not alter the argument 🙂

            I hope someone catches on and translates the Der Spiegel interview or helps us find a good translation. It would be a very useful reference but I do not feel competent to do a good translation myself even if I do not have any problem understanding the contents.

          • I’m not sure what you think are the ‘uncomfortable’ parts, Bjorn. The gist of the Der Spiegel interview is that TCM mutated Chinese medicine practically beyond recognition. Several commenters on this blog have tried to tell you the same thing – that what you view as Chinese med is a post-Mao bastardization of a traditional medicine system.

            You do seem to disagree with Unschuld (and every other researcher/translator) on definitions of terminology and historical methods of practice (like your insistence that acupuncture was all about blood letting, for instance, or definitions of qi and yin/yang, etc). I’m inclined to listen to the researchers.

            Personally, I don’t think you’d ever find Unschuld visiting a Chinese med practitioner. He seems to be a modern evidence kind of guy. But I say again, I think that makes his translations and historical research more valuable. And I’m not sure why you disagree with his findings (like his translation of the text on needling methods, for instance).

          • Strange.
            “Jm” now writes as if I am in disagreement with my own views!? I think (s)he must be somehow cognitively disoriented?
            My point the whole time has been that what we know today as “TCM” is a postmodern falsification, based on archaic, philosophic fantasies without any basis in research, trials or experience. None of it has been proven to work. The ancient magic that preceded it, Unschuld has sensibly suggested be called CTM- “Chinese Traditional Medicine” to clearly define it from the later invention of oriental Woo called TCM.
            Graphic insights into what CTM in reality consisted of can be found in Dugald Christies book, that “jm” consistently tries to dismiss as fabrication without producing any sensible reason for it other than his/her obvious own conflict of interest.
            CTM was in many ways very similar to the prescientific bloodletting and poisoning practiced in “the west” before the development of scientific medicine. The “west” and the “east” were not at all so segregated in antiquity as most people think. Medical ideas did not develop differently in isolation. They were exchanged back and forth and then developed some individual characteristics. There was ample trade and travel and exchanges of ideas, both sensible and silly. Blood letting was practiced on both sides of the Bosporus, in all cultures and the Chinese version of this was based on very similar philosophical, non-scientific ideas as the ones that prevailed in “western” antiquity and medieval times. To take an example, in the “west” there were four humors, in the “east” they were five, or rather six originally if memory serves me right -one got lost somewhere in time. I think Unschuld describes this somewhere.

            “Jm” ‘s confused claims of ancient oriental medical powers, is of course driven by a vested financial interest in continued belief. (S)he has admitted to be a professional purveyor of at least one if not two of the few remnants of original CTM injury based therapies, namely Gua Sha and cupping.
            His/her insistent claims that the bruises are not bruises but blemishes or whatever, and they only appear if something is wrong and needs to get out, is nothing but imitative magic based on pure fantasy.
            Gua Sha consists of scraping the skin to produce widespread red marks (ecchymoses) for virtually any ailment. “Cupping” has been converted to a variation on bruise-production “therapy” but is in reality a remnant of ancient bloodletting techniques originally devised to facilitate the extraction of blood from small cuts in the skin. Today most purveyors of this nonsense use the “benignified” version omitting the bleeding lacerations and only produce the suck-marks, so many gullible “worried-well” seem to be taken by. Cupping is nothing but a fraudulent, lucrative “sting”, popular in the more affluent parts of our world where the rich worried-well are easily lured.
            Cupping, for the original purpose, to suck out blood, can still be encountered in some cultures, namely the arabic ones. I found a video on YouTube (below) showing dimwitted fanatics in the UK practicing “wet-cupping” as it is generally called. The Arabic name of this useless and potentially harmful practice is “Hijama”.
            Remember, they killed George Washington in 1799 by overzealous wet cupping 😉
            The use of Cupping and Gua Sha today can only be categorised as the victory of marketing of misconception over reason and critical thinking.

            “Hijama”, AKA “Wet cupping”:
            https://youtu.be/mhOdwwuMJPQ

          • Strange indeed.

            “The ancient magic that preceded it, Unschuld has sensibly suggested be called CTM- “Chinese Traditional Medicine””. Not according to Unschuld – he points out that Chinese medicine shifted from magic to natural law in about the 3rd century BCE, in his book.

            “Graphic insights into what CTM in reality consisted of can be found in Dugald Christies book, that “jm” consistently tries to dismiss as fabrication without producing any sensible reason for it other than his/her obvious own conflict of interest.”

            I’ve never dismissed it – it’s a slice of one person’s experience, as the author clearly states. The sensible reason you’re looking for, again is in Unschuld’s book. And I have no conflict on interest – I don’t practice Chinese medicine. I’ve actually never even received a TCM treatment.

            “CTM was in many ways very similar to the prescientific bloodletting and poisoning…” Also not true, according to Unschuld’s book. I actually have received Chinese bloodletting…and it involves less than a teaspoon of blood. And pain is instantly removed. Bloodletting that is often referred to on this site is quite different, both in theory and in practice. But, very similar to some ancient Greek methods.

            ““Jm” ‘s confused claims of ancient oriental medical powers, is of course driven by a vested financial interest in continued belief. (S)he has admitted to be a professional purveyor of at least one if not two of the few remnants of original CTM injury based therapies, namely Gua Sha and cupping.”
            Again, I have no financial interest in Chinese medicine, and don’t practice any of it. Scraping and cupping are not Chinese (although they used it, too). It’s also not based in belief, but in observation and palpation. But, some of my teachers were Chinese med practitioners (which is how I know your gua sha info is made up).

            “His/her insistent claims that the bruises are not bruises but blemishes or whatever, and they only appear if something is wrong and needs to get out, is nothing but imitative magic based on pure fantasy.”
            Again, untrue and easily demonstrated. Geez Bjorn…such a long post, and so far very little is accurate.

            “Gua Sha consists of scraping the skin to produce widespread red marks (ecchymoses) for virtually any ailment.” Nope. You’ve taken bits of info, and gone wacky with it.

            “Cupping has been converted to a variation on bruise-production “therapy” but is in reality a remnant of ancient bloodletting techniques originally devised to facilitate the extraction of blood from small cuts in the skin.”
            Nope. Other way around. You have reality in reverse. At some point, people figured out that cupping would aid bloodletting – it didn’t start that way, and with the exception of Hijama, it’s rarely used with bleeding.

            “Cupping, for the original purpose, to suck out blood..” Still no.

            “Remember, they killed George Washington in 1799 by overzealous wet cupping.” And Hijama is totally different than Washington’s ‘treatment’. You should know that. Trying to sneak one in for effect, eh? You sly devil. Hijama and Washington’s death are both pretty well documented.

            All that, and you still didn’t answer why you disagree with Unschuld (and every other researcher/translator) on definitions of terminology and historical methods of practice.

          • Another curious demonstration of selective, cognitive deficit.
            FWIW, I do not disagree at all with PU. What he says, notwithstanding any beliefs or interests, corroborates well the the facts supporting the utter fictionality and folly of CTM/TCM.
            … sigh!

            Now, on to more frutiful pastimes than argumenting with a trolling quack.
            Actually it’s good practice for more discerning discourse, but there are limits.

          • Actually Bjorn, the only thing you seem to agree with PU on is that TCM is a mutated form of CTM. Needling methods & history, definitions of terms, etc – you definitely disagree. I can post links to some of your comments, if you’ve forgotten…

            Lots of people all over the world know that at least some aspects of Chinese medicine are quite effective, even if there is no scientific evidence to prove it. Most places (US & UK included), people know when to use modern medicine and when to use traditional medicine.

          • One might think “jm” is agreeing that TCM is a postmodern falsification based on CTM (an ancient fabrication), but…

            Needling methods & history, definitions of terms, etc – you definitely disagree

            …wrong about my opinion, again. 😛

          • “One might think “jm” is agreeing that TCM is a postmodern falsification based on CTM (an ancient fabrication)”

            One certainly might, if one actually read what I wrote.

  • The ‘primo-vascular system’ explains acupuncture meridians?

    Electro-acupuncture is an advance on traditional acupuncture?

  • The main fallacy I note, coming from the Consultant (!) and nurses involved in Pain Management Clinics I have contacted, is that there is increasing scientific evidence that acupuncture is effective.

    From the local University who ran a degree course, since hived off to a local college, again scientific evidence with the appeal to tradition in particular TCM.

    As far as friends who use acupuncture goes, the fact that it is offered on the NHS gives an appeal to authority. And from some, the naturalistic fallacy.

    Certainly to get the NHS to dispense with acupuncture in pain clinics would help and not to buy in services from private clinics who offer it.

  • A few additions:

    1. Acupuncture is drug free therapy
    2. Acupuncture is widely practiced in China, the most populous country on earth.
    3. Acupuncture is repressed by the Medical Establishment.
    4. Acupuncture realigns the chakra.

  • @ Ray Haupt

    1. Acupuncture is drug free therapy
    Therapy is by definition something that works, so acupuncture cannot be called therapy. Alternative therapy is by definition something that cannot or has not been proven to work. Acupuncture has been tried and tested and still doesn’t work.

    2. Acupuncture is widely practiced in China, the most populous country on earth.
    Actually not.

    3. Acupuncture is repressed by the Medical Establishment.
    The medical establishment opened its arms wide to it but acupuncture repressed itself by proving non-effective. Very many of my close colleagues tried it with great interest but all gave up because it simply didn’t work for real.

    4. Acupuncture realigns the chakra.
    Chakra is not a real thing, only a figment of imagination. No one has been able to confirm there exists such a thing.

    I could go on at length with references and arguments to support these replies but I do not need to. The burden of proof is upon you to prove me wrong and verify your claims 😉

    • I think Ray Haupt was providing additional examples for Prof Ernst, not trying to defend acupuncture. Anyway…

      3. Acupuncture is repressed by the Medical Establishment.
      The medical establishment opened its arms wide to it but acupuncture repressed itself by proving non-effective. Very many of my close colleagues tried it with great interest but all gave up because it simply didn’t work for real.

      This is part of the “You haven’t tried it so you’re not fit to judge” and ” just closed-minded” group of fallacies.

      In my case (WARNING! Anecdote) I have tried acupuncture. For sciatica pain. I stopped because the treatment made the pain in my hip worse. Funny how this sort of thing never turns up in testimonials.
      (Not, I hasten to add, that my doctor – a real doctor, who also did acupuncture – would use anecdotes. He firmly believed acupuncture relieved inflammation, and only inflammation.)

    • @ Bjorn

      While you are certainly correct on these points, I think you missed the point of Ray’s post which was to respond to Prof Ernst’s request for additional fallacies, which I think you will agree he has successfully provided!

    • Björn

      I think Ray was merely adding to Edzard’s list of fallacies and not putting them forward as valid reasons himself!

  • We have weathered differences regarding the purported supremacy of cochrane reviews as evidence of medical truth.

    Let’s see what John Ioannidis says about the reliability of Cochrane reviews and how we should approach them. This is from an interview on Retraction Watch (RW). The title of the interview is telling: ““Evidence-based medicine has been hijacked:” A confession from John Ioannidis”
    Here’s an excerpt. I recommend reading the whole thing:

    RW:You’re worried that Cochrane Collaboration reviews — the apex of evidence-based medicine — “may cause harm by giving credibility to biased studies of vested interests through otherwise respected systematic reviews.” Why, and what’s the alternative?

    JI: A systematic review that combines biased pieces of evidence may unfortunately give another seal of authority to that biased evidence. Systematic reviews may sometimes be most helpful if, instead of focusing on the summary of the evidence, highlight the biases that are involved and what needs to be done to remedy the state-of-the-evidence in the given field. This often requires a bird’s eye view where hundreds and thousands of systematic reviews and meta-analyses are examined, because then the patterns of bias are much easier to discern as they apply across diverse topics in the same or multiple disciplines. Much of the time, the solution is that, instead of waiting to piece together fragments of biased evidence retrospectively after the fact, one needs to act pre-emptively and make sure that the evidence to be produced will be clinically meaningful and unbiased, to the extent possible. Meta-analyses should become primary research, where studies are designed with the explicit anticipation that they are part of an overarching planned cumulative meta-analysis.

    This is exactly what some of the Cochrane reviews of acupuncture are doing, trying to provide credibility, however circuitous, to severely biased studies of something that has neither been shown to work or be able to work.

  • I just learnt that the new draft NICE-guidelines for Low back pain no longer recommend acupuncture as an effective therapy.
    https://www.nice.org.uk/guidance/indevelopment/GID-CGWAVE0681/consultation/html-content

    • Thank you for this link Professor!
      Very important document for those (like me) who have patients with difficult back problems. Even if this is still in the draft stage I am very interested in the present situation regarding real treatment options for chronic back pain.

      The guidance developers’ total slaughter of acupuncture as an option for treating lower back pain with or without sciatica is of course a huge milestone in the efforts against alt-med idolatry.
      Not only has acupuncture been thoroughly analyzed in this enormous effort, the word occurring 346 times, they even had a dishwasher-proof acupuncturist on board, one Dr Jens Foell. If I am not mistaken, Dr. Foell is a GP and teaching fellow at Imperial College London, as well as a medical acupuncture practitioner with his own private practice. He is said to regularly provide NHS patients with something called “medical acupuncture” and be part of the council for the British Medical Acupuncture Society.

      The overview on invasive treatment options can be found on page 8 in the main document where the message regarding acupuncture is quite clear:

      13. Do not offer acupuncture for managing non-specific low back pain with or
      without sciatica

      The guideline document draft contains a protracted analysis of acupuncture research for lower back pain with or without sciatica starting at page 457.

      The coup de grace can be found on page 496:

      The GDG considered that there was a substantial body of evidence relating to
      acupuncture in this review and that further research was unlikely to alter
      conclusions.

      (The emphasis is mine)

      It will be interesting to read about indubitable LBP/sciatica treatment options tomorrow.

      • Couldn’t fall asleep without having a peek at what NICE says about chiropractic for LBP/sciatica.
        So I rose and had a look and found… practically nothing!
        Chiropractic is mentioned virtually in passing as one of many types of manipulative practices. More interest seems to be directed at “massage” (226 occurrences) than “chiropractic/-ors” (45 occurrences, many of them in the research listings and references) or “adjustments” (9 occurrences).
        Interesting. I thought chiropractic would have been a big heading in the context of lower back pain and sciatica.

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