MD, PhD, MAE, FMedSci, FRSB, 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.

216 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.

    • Acupuncture is a scam. There is NO evidence that is effective in treatment or why it even it would be effective. You are only injuring the cells which are being punctured, risking infection and other side effects. Only the placebo effect helps patients feel better.

      If I told you I am going to stab you with a knife and it would heal you. You would think I am crazy. Acupuncture is the same thing only the stabbing is done with a much smaller item. There is no difference other then the size of the wound.

    • hi i am a doctor Chinese tradiconal a formation of more than 30 years not 4 master kenpo for over 20 years and come from a long tradition of medical I can tell you that despite his great 4 years of traditional aprendisage and anatomy you defend bad because the doctor is right in published ling shu brand that never puncturing the shu points that cause death there is a whole chapter indicating that the puncture is proibida forgive you saying this but read classical literature I assure science and MSCT are not fought in fact the real Chinese medicine is universal physiology can show all with the clear modern science if both languages seriously in my country speak until the investigation is corrupt is not taken into account antesedentes it’s just magic and anatomical areas according to new teachers are not dangerous and you saw that if it may be necessary rereading the classics I recommend ling shu ,and if the doctor says how well we are myopic why not study the ancient or modern literature only what we believe is ours and then we say is our base do a mix of malpractice accompanied by the magic he works so I was taught it is time to become aware if called tradition read the classic you and all those who follow tentatively dangerous practices if they did not shu represent danger of death according to wHO not deven be practiced if they pose minimal risk to life despite his long years as a doctor of tradition or the basic anatomy of fact in this case science supports the classic not deven be pricked by causing death literature is very espesifica it is used moxa not punctured used moxa so both his defense argument in favor of training without obvious farzantes have not read the minimum alvertencias is refreshing thanks for your attention

      • I read only the half of it then i was out of air. Man, try to use points! It’s really hard try to follow your arguments like this >.<

  • 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?

    • Are you sure there is “zero evidence” of any benefit of any kind?
      Maybe a little search of Google Scholar is required

    • if called tradition read the classic you and all those who follow tentatively dangerous practices if they did not shu represent danger of death according to wHO not deven be practiced if they pose minimal risk to life despite his long years as a doctor of tradition or the basic anatomy of fact in this case science supports the classic not deven be pricked by causing death literature is very espesifica it ling shu what proive says only used moxa not used moxa punctured therefore its defense argument in favor of training without obvious farzantes have not read the minimum alvertencias is refreshing thanks for your attention

  • 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

      • Basically you just go on replying to people without providing facts. How come its not 2500 years old?!

        • How come its not 2500 years old?!

          Because known historical facts render it not only implausible but totally impossible that the practice we call acupuncture, existed before the 20th century.
          One small fact, for example, is that the technique of manufacturing thin, sturdy needles needed for acupuncture, did not exist until about 400 years ago.
          Before the “invention” of acupuncture, the practice was nothing more than a parallel to other prescientific methods known all around the world, of bloodletting and poking into the body with coarse instruments.

          There is a lot of interesting material to be found that corroborates this. Much of it is to be found by searching for “acupuncture” on this site:
          http://www.sciencebasedmedicine.org/

          The latest article that covers much of the answers to your question is here:
          http://www.sciencebasedmedicine.org/retconning-traditional-chinese-medicine/
          There, you will find information about how it came to be.
          Here is another source of information about the “invention” of acupuncture:
          http://www.slate.com/articles/health_and_science/medical_examiner/2013/10/traditional_chinese_medicine_origins_mao_invented_it_but_didn_t_believe.2.html
           
          Read also the enlightening book “Thirty years in Moukden 1883 – 1913”, by Dugald Christie, published in New York in 1914.
          It can be downloaded in electronic facsimile from here: https://archive.org/details/thirtyyearsinmo00chrigoog

          • and of course bone or gold needles could not be used…
            http://drweil.smugmug.com/keyword/shanghai/

          • and of course bone or gold needles could not be used…

            They were used indeed once upon a time. Mr Christie describes well (in the last reference in my comment above) how the available pointed instruments at that time were used and for what. As Andrew Weil’s (do you know that old crackpot?) photos to which you refer show, several forms of pins and lances of all sorts have been found or preserved, which are thought or known to have been used through the ages to stick into the body of the sick and suffering in the hope of producing a curative effect.
            Needle in Latin is “acus” and the word “acu-puncture” means litterally “needle-puncture”. Since higher primates first came to imagine that it could have a beneficiary effect, acu-puncture has been the practice of sticking whatever sharp object available into the body in the hope of affecting a heal or cure. But just like in “western” blood-letting, the cure was usually worse than the disease. Fallacies and biases prevented rational insight into this little problem until reason and scientific approach became popular and modern medicine evolved.
            As Mr. Christie describes, acu-puncture was still at the end of the nineteenth century a terribly crude form of pre-scientific torture often resulting in suffering, infection and death.
            After its re-invention in the early twentieth century, acu-puncture using clean, filiform steel needles is not as inherently dangerous* or torturous but no more effective.

            *The Candian former Judo champion ask Kim Ribble-Orr and former South Korean president Roh Tae-woo might wish to challenge this statement and tell you a thing or two about the perils of thin steel needles.

          • It’s fascinating to watch how you support your fantasy world, Bjorn. It’s like an episode of “Fractured Fairy Tales” from the Rocky & Bullwinkle show.

          • @jm
            Lots of talk, no substance. Please provide some evidence.

          • Dont’ be so hard on yourself, Bjorn. You talk a lot, but there actually is some smattering of substance. You just have an odd way of connecting the dots, which leads to some whacky conclusions. Keep trying though. Perseverance furthers.

            (By the way, your reference to Judoka Ribble-Orr is a good reminder to not let your massage therapist needle you.)

        • @John – Obviously, acupuncture has been used as a treatment method for at least the past 2200 years. Edzard and Bjorn (and some others) consistently confuse acupuncture with TCM. If you keep that in mind…some of the statements & comments on this site make a bit more sense. Or at least makes them a bit less bizarre. I’ve found that it’s best to have a big grain of salt handy regarding Eastern medicine on this site, as many terms and concepts are not well understood, and used in a very sloppy manner.

          • …and we constantly ask “jm” and his likes for evidence for their persistent fantastical claims but get nothing more convincing than insinuations, straw man arguments, ad hominem polemic and other lame responses.
            The only retrievable original reference I can recall them producing is an antique book, which is supposed to contain a useful key to the alternative “eastern” way of dealing with disease.
             
            Here is a passage from that book:

            Yellow Emperor asked: “What is the diagnostic method in pulse palpation?” Qibo answered: “The palpation of pulse should be carried on in early morning, when the Yang-energy has not yet stirred, the Yin-energy has not yet been dispersed thoroughly, the food and drink of man have not yet been taken, the channel-energy then is not in hyperactivity, the energies of the collateral branches of the large channels are in harmony and the energy and blood have not yet been disturbed. In this situation can the pulse condition be diagnosed effectively.
             
            “At the same time of diagnosing the dynamic and static variations of the patient’s pulse, his pupils and complexion should be inspected, so as to distinguish whether his energies of the five viscera are abundant or not, his six hollow organs are strong or not, his physique and energy are prosperous or not. When these aspects are considered comprehensively, one can judge the date of the death or survival of the patient.

            This ca. 2400 year old book is apparently written as a dialog between the author the yellow (jaundiced?) emperor and his minister(s) or physicians because he did not want to be held liable should the advice not produce desired effects 😉 Translations are as varied as they are many and, as the interpretation of ancient chinese seems to be rather problematic, modern translators tend to adapt the text to fit their own fantasies as exemplified in this rather revealing abstract.
             
             
            A useful and practical manual of medical methodology for helping the sick and injured? Nah…
            Perhaps it contains scripts, well suited for theatrically entertaining the worried well for a brief moment but there are sick and suffering patients out there in need of effective help.
            I think I’ll stick to what works.

          • Bjorn – I see you’ve only gotten slightly better at hiding your racism. One step at a time, I guess. Did you at least figure out the difference between TCM and acupuncture?

          • The “racism” ad-hominem once again. Pathetic.

          • We’ve talked about the whole ‘jaundiced’ thing before. But at least you quit using ‘chinamen’. Pathetic indeed.

            When you’re done reading about pulses in the Nei Jing, read up on needles. They’re pretty much the same today as they were then. The filiform needles are a bit thinner, and most are now single use & disposable. But used the same way. Keep working on those ‘historical facts’ that you’re so certain about.

          • Once again, “jm” makes it up as h(s)he goes but does not provide evidence or references.
            My somewhat lighthearted question, whether the prefix “Yellow” in the title of her/his favourite book may be due to him having been jaundiced, has apparently deeply wounded “jm”‘s admiration for his/her idol. This 2000+ year old book may be historically interesting but proves nothing about the value or virtues of TCM or acupuncture.
             
            That thin, “filiform” needles could have been used earlier than a few hundred years ago is a historical impossibility. If “jm” has evidence to the contrary, that the metallurgical techniques needed existed 2000 years ago, she/he should be able to produce it. It would turn many a historians hair to grey.
             
            The “classical” needles in ancient chinese medicine were nothing like the thin needles that came to be used when “acupuncture” was reinvented during the earlier part of the twentieth century.
            Here is a picture of a typical set of the nine instruments, which made up the classical toolkit of TCM. The text (written by modern acupuncturists) attempts to equalise the thinner classical needles with the thin wires used today but as anyone can easily see, the thinner pokes are at least 20G if not more.
            How were these instruments used? They were used (non-sterile) to draw blood and poke deep into the body of the subjects to let out imaginary life forces, wind or fire or whatever.
            The Scottish missionary surgeon Mr. Dugald Christie describes this in his book “Thirty years in Moukden 1883 – 1913”. The book can be retrieved in its entirety in electronic form.
            “jm” has previously blurted something about this book not being admissible evidence but as usual he/she has not provided a morsel of evidence to substantiate that claim, despite being asked for it repeatedly. I seem to recall that (s)he wrote something about one needing to have a look at the map to understand what (she) was insinuating!? When asked whether the Manchuria was not part of the oriental world form where this marvelous magic is supposed to have been practiced, silence ensued.
             
            Anyway, Dugald Christie’s accounts of how blood was drawn from sick children by poking them under the fingernails or how a little girl with stomach aches was lanced into her belly and died in miserable peritoneal agony in his helpless hands, does not exactly conform with “jm’s” fantasy, does it?

          • Well hey there Bjorn,

            – “My somewhat lighthearted question, whether the prefix “Yellow” in the title of her/his favourite book may be due to him having been jaundiced”

            Ohhhhh….you thought he might be jaundiced because of the “Yellow” prefix! You really thought that, did you? My mistake.

            – “That thin, “filiform” needles could have been used earlier than a few hundred years ago is a historical impossibility. If “jm” has evidence to the contrary, that the metallurgical techniques needed existed 2000 years ago, she/he should be able to produce it. It would turn many a historians hair to grey.” No metallurgical evidence for you Bjorn. Sorry to let you down. If it’s any consolation, from what I hear, thin needles were made from bamboo or jade. (and gold and silver, of course) Even then, still probably not nearly as thin as modern stainless steel needles.

            – “The “classical” needles in ancient chinese medicine were nothing like the thin needles that came to be used when “acupuncture” was reinvented during the earlier part of the twentieth century.”

            Actually, the filiform/hair-fine (whichever translation you want to use – since the term ‘filiform’ seems to upset you, we’ll go with the ‘hair-fine’ translation) and the long needle look a whole lot like the ones being used today. Only thicker. The ones that were for actually drawing blood & draining wounds…not sure what most folks are using. My acupuncturist uses lancets. The couple that are for massage (round needle, spoon needle), I have a couple that look remarkably similar. Anywho, they’re used the same way now as they were way back when. Tonify, sedate, disperse, dredge. Grasp the qi, needle to the depth of the disease, etc etc.

            – “Here is a picture of a typical set of the nine instruments, which made up the classical toolkit of TCM.”

            Here’s one back at ya:

            http://www.ib3health.com/products/AcupunctureNeedle/AncientNeedle.asp

            This is a replica set of the gold & silver needles they found in Mancheng, in a tomb from 113 BC. Apparently the gold ones lasted quite well, and the silver fell apart a bit. Who knew that after only 2100 years, thin silver needles would deteriorate? (probably a grey haired metallurgist) But of course, replicas were made. I was going to say you could buy your own set, but looks like they are out of stock.

            – “How were these instruments used? They were used (non-sterile) to draw blood and poke deep into the body of the subjects to let out imaginary life forces, wind or fire or whatever.” You forgot to mention that they were also used superficially, sometimes to let blood, sometimes not. Sometimes to tonify, sometimes to disperse, etc. Turns out they made those choices intentionally. After years of observing, trial and error, developing and testing theories, all that old science stuff that you like to pretend doesn’t exist.
             
            – ““jm” has previously blurted something about this book not being admissible evidence but as usual he/she has not provided a morsel of evidence to substantiate that claim, despite being asked for it repeatedly.”

            I think the author states at the beginning of the book that it’s all anecdote, yes? Aren’t you one of the loudest voices on this site saying anecdote is not evidence? So really…you’re the one dismissing the book. (But you get extra points for using the phrase ‘admissible evidence’.) Or making it inadmissible, or whatever. I still haven’t read it. He was there during the opium wars, the boxer rebellion, and the self strengthening movement, yes? Too bad you weren’t with him – that would have been a great time to get answers to your jaundice question, as I hear Europeans were really popular in China at that point in history.

            – “Anyway, Dugald Christie’s accounts of how blood was drawn from sick children by poking them under the fingernails or how a little girl with stomach aches was lanced into her belly and died in miserable peritoneal agony in his helpless hands, does not exactly conform with “jm’s” fantasy, does it?”

            Oy, you should hear the stories I get pretty regularly from botched knee & hip replacements. Makes your skin crawl. Or the probably permanent damage from streams of antibiotics trying to track down the mystery bug. Or the “pain is all in your head” folks that are at their wits end. Or MRSA they got in the hospital. (shouldn’t things be sterilized in the hospital?) Etc etc. All from modern medicine, can you believe it? But they are only anecdotes. So they don’t count…which works well for your fantasy, doesn’t it?

          • I think we now have ample evidence that “jm’s” comments can from now on be totally ignored as irrelevant.
            His/her last comment is a showcase of half-witted fabulations, fallacies and faux-pas’s that I am not going to bother addressing.
             
            Suffice it to say that (s)he has now provided his/her first credible proof and that is of his/her total lack of respect for the dialog.
            I did actually, on “jm’s” suggestion read accessible passages from “The Yellow Emperor” and found them interesting but useless. I did paste an example above. From what I understand, modern translations of this ancient instruction manual of magical ministrations have been heavily edited and adapted to support the fantasies of modern “acupuncture”.
             
            “jm” has in the past commented verbosely on Dugald Christie’s book, which is a very important verification of the nature of tcm and its recent history. “Jm” has vehemently commented on the lack of validity of this book and the historical evidence therein and now adds more of his own conjecture to the heap.
            Dugald Christies first hand account of the nature and practice of traditional Chinese medicine is FREE to download in its entirety (link in my comment above). Nonetheless this noname now admits to never even having read the book, not even the introduction, which (s)he has based several assumptive comments on (my emphases):
             

            I think the author states at the beginning of the book that it’s all anecdote, yes?
             

             
            I still haven’t read it

             
            QED

          • It’s interesting what qualifies as anecdote. I guess it depends on who is posting it? There must be a formula somewhere… Anywho, here you go Bjorn, the beginning of the book:

            “This is not a History, still less is it an Autobiography. It does not attempt to give a complete account of Manchuria, nor even of Moukden, nor to depict minutely its people and their customs. There are important missionary developments which are not alluded to, or only lightly touched upon. Books on Manchuria, and on its wars, and on its Missions have already been written. This only attempts to deal with personal impressions, and to give a picture of life amid the Changeless East of the olden days, and amid the rapid march of events which have brought.”

            And I think I told you before, I don’t find it ‘invalid’. I think personal accounts are quite valuable. But, since I don’t practice acupuncture…Christi’s book isn’t at the top of my reading list. One nit-picky thing though: you say his book “… is a very important verification of the nature of tcm and its recent history.”

            Not quite. I have read enough of the book to know it has nothing to do with TCM.

          • Sorry Bjorn, forgot to add this:

            “From what I understand, modern translations of this ancient instruction manual of magical ministrations have been heavily edited and adapted to support the fantasies of modern “acupuncture”.”

            Some of them…but certainly not all of them. You do have to be picky.

  • 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.

    • It is interesting to see who has posted when they provide a link.

      Susan Anderson operates http://oceansway.com/, a naturopathy and acupuncture clinic in Newport, Oregon.
      Here are more links;
      http://oceansway.com/sciatic-pain-treatment.html
      http://oceansway.com/about.html

      It seems Susan is an obese, middle-aged woman who has “studied” two alt-med areas and has offered this, among others, as an intravenous treatment;

      “Standard Push
      Sometimes called a “Myer’s Cocktail”, it has been useful for a variety of symptoms including acute asthma, migraines, fatigue, chronic fatigue, fibromyalgia, acute muscle spasm, upper respiratory tract infections, chronic sinusitis, seasonal allergic rhinitis, and cardiovascular disease.”

      Who said, “Physician heal thyself”?

  • 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.

      • Basically your aim is to lobby against acupuncture. You just revealed yourself. Cool, at least that is cleared up.

        • “Basically your aim is to lobby against acupuncture. You just revealed yourself. Cool, at least that is cleared up.”

          What was “cleared up” is that acupuncture is a pointless and unnecessary farce, practised for profit and no health benefit, apart from a mild placebo effect. Is that “cool” too?

  • 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.

    • An alt-med writes like they think; a stream of conciousness devoid of structure and reason.

      http://www.danielschulman.ca/Daniel_Schulman_-_Classical_Acupuncture/The_Front_Door.html

  • 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.

    • Tom Kennedy is an acupuncturist from Bristol, UK, who takes victim’s pulse in BOTH arms in the hope they are different. While the amplitude may be different for many reasons, the frequency is unable to change, unless some have two independents hearts. (Dr Who anybody?) He also does some “fishy” (disparagely intentional) massage: tuina (Chinese massage).
      http://www.tomtheacupuncturist.com/#tom-kennedy-tuina-acupuncture-bristol

  • 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.

  • A bit odd no one is mentioning, the blindness, deaths, brain injuries, strokes and heart attacks happening from the administration of pills and western “science and medicine” daily. Not to mention the pills abuse and addiction. Western medicine is an industry not based on curing but hiding symptoms not attempting to fix the root of the problem.Treatment is a never end toss of dollars to that industry, of course doctors do not want you “cured”, they will lose business. So doctors rather subdue chronic ailments and keep you coming back to their offices while forking out cash for prescription pills. What a crooked world they weave.

    I am picking up a very Eurocentric vibe from this article. The west is best and their judgement rises above all others in the world. I have been administered pills by mistake, my grandfather died from a lobotomy from “western medicine and surgery”. Get off your high horse western white medicine, you have a lot of deaths caused by your hands.

    Excuse me, whilst I pop another pill and die of a heart attack from your mild “side effects”.

    • @Too amusing

      This blog also doesn’t say much about the numbers of lives saved by conventional medicine, the number of people living longer and with a higher quality of life because of conventional medicine, the number of babies who survive birth because of conventional medicine and the number of those who are suffering less and in less pain because of conventional medicine.

      But that maybe because it’s about alt med.

  • bush did 9/11

  • A news item from Norway about a fatality from acupuncture.
    A 64 year old man developed a streptococcal infection in the hand after being “treated” with acupuncture. I have been unable to find information about the indication for the procedure, which was performed by a student under supervision.
    The regional Norwegian medical authorities did not find reason to put blame on anyone as the occurrence of infection after acupuncture was to be expected albeit rarely. They did not even mention anything about the indication or efficacy of the procedure.
    According to a Norwegian news article the man was stuck in the palm of the hand.
    Here is brief account in English.
    http://norwaytoday.info/news/man-dead-acupuncture-treatment/

    As there is no valid evidence that acupuncture is efficacious or beneficial for anything, any untoward reaction or complication is unacceptable.

      • so would I!
        alas it is not new but based largely on a previous publication: http://edzardernst.com/2012/10/acupuncture-for-chronic-pain-almost-certainly-not/

        • No, there is significant new material.

          • I don’t deny it but said it is ” based largely on a previous publication”

          • This new study adds nothing to the meta-analysis of Vickers et al. which demonstrated that acupuncture has little or nothing, other than placebo effects, to offer sufferers relief from chronic pain.

            The osteoarthritis meta-analysis suffers from the same defect as the original by Vickers et al. Some of the included acupuncture studies do not have sham controls, thus biasing the meta-analysis results towards acupuncture. A difference of 5.56 on 0-100 scale is scratching the barrel of clinical meaningfulness, and could be due to residual bias.

            Again, the new study did not control for specific effects when comparing acupuncture with usual care for depression. Given the fact that acupuncture was no more effective than counselling, it is virtually certain that they are both evincing placebo effects. How likely is that the physiological effects of having needles stuck into the body, can translate precisely into the same relief from mental torture as that provided simply by means of kind and thoughtful human support?

            It’s more likely that having someone trying to help you is what counts.

            Nothing new really.

          • thank you – I was going to scrutinise the paper over the weekend [only so that Tom is happy]. you saved me time which I desperately need for other things [deadline for next book!]

          • Sorry, the difference of 5.56 is between acupuncture and sham.

      • @Tom Kennedy on Thursday 30 March 2017 at 20:28

        I read it, between the guffaws and belly laughs. It is a bunch of acupuncturists, using any sleight of hand possible, to try to justify an outcome in the silliest of studies. Even the abstract gives it away; neutral and impartial it is not.

        It doesn’t surprise me you would dig up this crap and try to pass it off as credible. It is so bad, even my very low opinion of you is lowered further.

  • @Edzard largely maybe, but there is significant new information which shifts the needle. As a scientist, you will appreciate that new information should always be incorporated into an ever-evolving understanding of the truth, and this latest analysis suggests a promotion of acupuncture’s status beyond placebo, wouldn’t you agree?

    • @Tom.

      Of course we take all new data and evidence seriously. I for one would love to find something that helped me better with my own arthritis. I have not seen evidence yet good enough to convince me that going to an acupuncturist would be worthwhile. When you or anyone else can demonstrate persuasive evidence thereof, I promise I will.
      There are massive problems to be taken into account when analysing existing research in this field.
      The document you link to Tom, is immense. It is not something you do in one day, assessing the quality and validity of such an opus.
      I had a look over the text in chapter3: Comparison of acupuncture with other physical treatments for pain caused by osteoarthritis of the knee: a network meta-analysis
      It is a curious approach to say the least. The authors seem to have set out to substantiate acupuncture.
      They mix together very different genres of “physical treatments” and try to compare symptom scoring (WOMAC) with each other and all of them at the same time, jumping through endless loops of statistical inferences. They say pain in the title but in WOMAC is a combined symptom score? Whatever… That is a minor quirk.

      There are several known problems with all research on acupuncture that I could not immediately see the authors addressed or took into account. I do not have time at present to delve deeper into this but perhaps you can help out with a few questions regarding some of them?

      First, I did not find any mention of attempts to define what type/kind of acupuncture they were taking into the analysis. I may have missed it. There are literally hundreds of different schools of acupuncture and the different permutations of needling can be trillions. Were they looking at one or at least a somewhat homogeneously defined way of needling for osteoarthritic pain of the knee ? Or did they throw into the pot anything the authors of each acceoted study called acupuncture?

      Second. There is the problem of electro-acupuncture. Very many studies that say “acupuncture” in the title and abstract, really are studies of PENS – percutaneous electrical stimulation. This is not acupuncture, has nothing to do with it except the fact that the skin is pierced. Such studies should be in a group of their own. Did the analysts in this work discern between acupuncture and PENS? I may also have missed this.

      Third. It is an established fact that studies on acupuncture from research groups in China practically never report negative results. A large part of acupuncture studies and some of them are of such (apparent?) quality that they fulfill criteria for inclusion in meta-analyses and reviews. Another problem with studies from China is the known fact, confirmed by Chinese authorities, that 4 out of 5 scientific studies published, that originate in China are counterfeit.
      Did this review in any way try to ameliorate this immense problem, for example by using stricter criteria on studies emanating from China or excluding them?

      Of course there is then the statistical problem with multiple comparisons and the question of statistical difference versus clinical utility, which to me seems questionable, but lets see if you can find answers to the questions above.

      Until proven otherwise, my impression of this (Chapter 3 only of course) is that the authors have shown what we already know and have evidence to support, that acupuncture is the strongest of many placebo methods.

      • Björn

        Have you thought of trying an acupuncture treatment for yourself? You state you have arthritis and acupuncture is often used with varying success in treating the condition. Yes there can be dangers with any invasive procedure but you must admit that crossing a busy road can present a higher risk. I would suggest TCM but in that I am a little biased.

        The problem with research into TCM acupuncture is there is no set protocol as each case is treated uniquely from the signs the patient presents. Yes the reporting of TCM acupuncture in general is woeful, Chinese research is a little biased to say the least and STRICTA has attempted to address reporting issues with little success. So where does this all leave us? There is a mountain of research on various aspects of an acupuncture treatment and a sizable hill on set acupuncture treatments of a vast number of conditions, yet when reviewed it is still relatively easy for advocates to cite primary research and reviews that show acupuncture in a positive light and for skeptics to cite primary research and reviews that show acupuncture in a negative light. Anecdotal evidence is shunned by academics, quite rightly, but patients that have had relief via an acupuncture treatment don`t give two hoots about what academics think.

        I am just coming to the end of my training in TCM acupuncture and have witnessed and participated in hundreds of treatments, the majority having a positive affect and a few with little or no effect but I have never witnessed a negative effect other than some slight bruising. The most memorable patient I witnessed was an 18 year old boy that had developed migraine like symptoms over the course of several months, he would get attacks several times a day lasting around half an hour and he was at the point of suspending his university studies. He had numerous tests and scans and had been told that other than medication for the pain there was little more that could be done. He attended our university clinic as a last resort and received three treatments, after the first he reported a reduction in frequency and intensity and by his third visit he reported no attacks in the previous week. Anecdotal evidence to you but to him a chance to lead a normal life. I have spoken to him a few times on campus and he is still attack free after nearly a year and able to continue studying.

        I have been training for three years and have safety drummed into us daily however the “Western” acupuncture practitioners train for six weeks. It would be interesting to see what the figures are like if a study was done on the adverse effects of acupuncture treatments performed by different styles (TCM by Chinese practitioner, TCM by western practitioner, Western, Japanese and so on)

        • @Keef
          It is always to be commended when people educate themselves but “education” does not automatically imply the gathering of true knowledge. It can just as well mean accumulation and reinforcement of delusions and deceptions.
          Of course you believe in the future you are investing in.
          But I would like to ask you to participate in a small experiment with me.
          I want you to take part of three documents that for me and tell me what you think after reading them carefully.
          The first is a little parable.
          When you say:

          The problem with research into TCM acupuncture is there is no set protocol as each case is treated uniquely from the signs the patient presents.

          …you are in effect saying research cannot consistently detect the efficacy in acupuncture, therefore research must be wrong. A little story by Carl Sagan beautifully illustrates the fallacy you are being fooled by. It is called “special pleading”.

          The next is an article by a fellow named Barry I. Beyerstein. It tells in simple terms of the factors at play when therapies without any efficacy of their own seem to be effective. Try to apply these factors to the ‘cures’ you have observed. For example the 18 year old. Remember that migraine is one of the most common conditions “cured” by any alternative therapy. ‘Migraine’ is a special type of disorder related to vascular phenomena in the prain and headache is only one of many symptoms. “Migraine” is very often only an over-diagnosis of simple stress-related headache that time, relaxation, suggestion, change in stress factors and simple reassurance work for. I dare say that was what ailed your 18-year old, right?

          The last one is one of many articles illustrating the history of TCM and acupuncture from another, less biased perspective than the one your teachers have surely presented. There are more god articles if you want to read more about the history of acupuncture that fits much better with contemporary information and known history. Try searching for the name “Ben Kavoussi” on sciencebasedmedicine.org

          I look forward to see your response to this ‘homework’.

          • Unfortunately I have other homework to focus on at the moment but I promise I will look at your suggested material in the near future.

            Of course there are always other mechanisms at play with any “cure” following an acupuncture treatment, just ask any skeptic. However I thank you for not covering me with an avalanche of the word “placebo”. Stressed or not the boy walked away without a headache and without a bag full of expensive drugs and a pad of repeat prescriptions.

            I noticed that you did not do your homework (an acupuncture treatment for your arthritis) or even comment on the suggestion of a treatment. Are we a little needle phobic? Be brave it does not hurt that much and you never know you may be surprised.

            I understand that you quite enjoy “baiting the acupuncturists” and that poorly administered treatments can risk harm to the patient but let us look at this from another direction, have you asked yourself how many serious illnesses have been spotted by acupuncturists who have then referred the patient on and possibly saved their life. In the UK a family doctor has around 8 minutes per patient while an acupuncturist can spend 20-30 minutes on a consultation alone thereby getting a much more detailed insight on that patient. If any studies have been done on this I would love to read them.

          • Acupuncturists are not trained or educated to spot serious diseases. Therefore, the number is likely to be low.

          • Just out of curiosity, what would it take to convince you acupuncture was a valid treatment of a condition?

          • how about evidence?

          • I am sorry to say this Edzard but you are wrong. In training for BSc (Hons) acupuncture we do have training to spot a variety of conditions, not just as contraindications to treatment and also correct referral paths depending on urgency.

          • I know, but this ‘variety of conditions’ does not nearly cover all serious diseases, and not all acupuncturists are educated to BSc level.

          • Edzard, have a treatment yourself.
            Some times the proof of the pudding is in the eating.

          • considering that you have a BSc, you are remarkably ignorant about the nature of evidence.
            perhaps you should read this: http://edzardernst.com/2012/11/what-is-and-what-isnt-clinical-evidence-and-why-is-the-distinction-important/
            (btw who tells you that I did not have acupuncture?)

          • Show me any doctor that can “cover all serious diseases”.

            Yes I agree not all acupuncturists are trained to BSc level however there are many that are. Your reputation for requiring quality research is famous yet you come out with a comment ” the number is likely to be low”, even a low number can be significant or am I wrong?

            I think that your comment has displayed your bias against acupuncturist.

          • did I say that the average doctor “can “cover all serious diseases”” ?
            no I didn’t!
            I think your comment again shows remarkable ignorance.

          • “Yes I agree not all acupuncturists are trained to BSc level however there are many that are. Your reputation for requiring quality research is famous yet you come out with a comment ” the number is likely to be low”, even a low number can be significant or am I wrong?”
            my statement is not research – maybe you need to read up about research as well?

          • @Keef

            In training for BSc (Hons) acupuncture we do have training to spot a variety of conditions, not just as contraindications to treatment and also correct referral paths depending on urgency.

            You may be lead to believe you are trained adequately in this respect but you are being mislead. Four decades of practicing medicine and surgery is one of several reasons why I know this. I do not need to have tried acupuncture myself to know it extensively, not any more than one has to be a victim of rape to know all one needs to know about rape.

          • I find that a little rude!!!!
            I suggest trying a treatment and you reply “you are remarkably ignorant about the nature of evidence”.
            I did read through your suggestion (just to exorcise my ignorance).

            If I treat a patient for a condition and that condition improves to the patients satisfaction then that is a positive result for the patient and therefore myself. In the case of the boy I described earlier, he had relief following the treatments, did not need to take a lot of drugs for an unknown length of time, saved money and avoided possible side effects. In my view a positive outcome for the boy and myself. It may not fit your view of evidence but when you see it over and over again in the treatment of all manor of conditions you begin to understand that research needs adapt to fit acupuncture not acupuncture fitting research.

            By the way my comment about not having a treatment was for Björn

          • as I already said: YOU ARE REMARKABLY IGNORANT

          • “I do not need to have tried acupuncture myself to know it extensively, not any more than one has to be a victim of rape to know all one needs to know about rape.”

            That one little sentence really gets to the heart of the matter, Bjorn.

          • I started participating in this not to try to convince anyone but to learn and hopefully one day add to the understanding of acupuncture. I have found that there is a bullying atmosphere if your beliefs do not fit.

            Edzard I was quite enjoying this discussion but your aggressive comments are totally unnecessary.
            It was YOU that said “does not nearly cover all serious diseases” I did not! I merely stated that we had training to spot a variety of things. I have not agreed with you but I do not resort to rudeness as I feel that is the domain of the ignorant, you must feel very at home there. Yes this is your site, you can rule it with all the force and cronies you can muster.

            Björn I think that rape comment was not only uncalled for but also remarkably stupid coming from a man in your position.

            jm Yes it does!

          • @Keef on Monday 03 April 2017 at 18:14

            “I started participating in this not to try to convince anyone but to learn and hopefully one day add to the understanding of acupuncture. I have found that there is a bullying atmosphere if your beliefs do not fit.”

            You typify non-med crackpots. The first sentence is disingenuous, while the sentence is the usual victim claiming. The discussion here is robust, little petal, and if you make outlandish, silly, unscientific claims, you will be advised.

            “Edzard I was quite enjoying this discussion but your aggressive comments are totally unnecessary.”

            The prof called you ignorant (about time for you to consult a dictionary instead of your emotions) because you are ……………………………… ignorant.

            “It was YOU that said “does not nearly cover all serious diseases” I did not! I merely stated that we had training to spot a variety of things.”

            Do you have such serious difficulties processing text or understanding logic. What if your “training to spot a variety of things” does not include a deadly disease from which one of your dupes may be suffering? You won’t know if they don’t seek proper medical treatment, don’t see them again and they die. Will you even be aware of your culpability?

            “I have not agreed with you but I do not resort to rudeness as I feel that is the domain of the ignorant, you must feel very at home there. Yes this is your site, you can rule it with all the force and cronies you can muster.”

            Please, little petal, your rudeness is the making of claims, devoid of any evidence, when there are others who are so aware, and others who see the results of your “handiwork”.

            “Björn I think that rape comment was not only uncalled for but also remarkably stupid coming from a man in your position.”

            The statement was made to make a point to someone who is remarkably abstruse, and the response proves the point.

            “jm Yes it does!”

            jm is a well known loon whose opinion about anything and everything should be taken as unhinged, except perhaps by the likeminded.

          • @Keef

            I am saddened by your reaction but I am not surprised and I am not regretful. Using rape as an example was fully purposive but is not to be perceived as an ‘ad hominem’ assault. I could just as well have said: “You do not have to have to be involved in a car accident yourself to know all about how serious injuries it can cause.
            Of course I am not insinuating that acupuncturists are rapists but to me, pretending to be a doctor and pretending to cure and alleviate real diseases with injurious but unproven interventions is not far from bodily assault. Forty years of attending to sick and wounded for real, have made me totally intolerant to those who pretend to be doctors and pretend to cure and alleviate diseases with make-believe medicine and fake methods.

            You have to understand that this blog is not a place you can come to and expect to find confirmation of paranormal beliefs that have no scientific backing and fly in the face of reality and reason. If you thought your hard earned acupuncture skills have a sound basis you are really in for a surprise here.
            I gave you homework in the hope you could prepare for this shock but you came unprepared to this lecture. I had intended to attempt to lead you through the reasoning and rational thinking we apply to this problem.

            This is a blog that monitors and examines all different varieties of medical imitation and fraud.
            When practitioners and apologists of make-believe medicine come to our door and present themselves, they are met like a Jehova’s witness or a pair of Mormon youths, who ring the bell of the home of someone who does not share their faith and is severely skeptical of the scripture they have been led to believe is the truth and nothing but.
            Such well willing visitors are met by most of us with courtesy and given an opportunity to present their case. If the visitor hides behind a veil and only presents itself with a silly pseudonym, the reception will inevitably be several degrees cooler and more easily become disdainful. If the visitor seems honest and shows his full credentials like our friend Tom Kennedy, he is met with the respect that any visitor deserves, as long as the behaviour remains acceptable.
            We still listen to Tom and we still hear him out because he is honest and open and true to his faith, but we also tell him what we honestly think of the information on his website and we also throw the occasional jovial scorn at his paranormal fantasies and strange beliefs. But we still like the person because he is honest and true to his calling.We do not approve of his sticking needles needlessly into people and I seem to recall we have given him advice on a career change. I think I would even look Tom up if I ever were in his town and had the time for a cup of tea and the rounds of his facilities. But I think I would courteously decline his suggestions of draining my damp heat or pacify my wind.

            To continue the parable of a Jehova’s witness calling at our proverbial door, we are more than happy to hear him out because we honestly are in search of better or new evidence, believe it or not.
            If the witness would be able to show us unmistakeable evidence of his beliefs, we would inspect this evidence critically and we would honestly adopt a more positive attitude if it was convincing. If the old bearded man in the sky who according to scripture calls the shots, really showed himself in person and did a few convincing tricks and a tug at the beard proved it real. Or if a credible,individually reproduced study showed that a long deceased son of his could feed five thousand with a few fish and a loaf of bread and a credible mode of action that fits laws of nature was presented, then we would consider this evidence and adjust our own world view accordingly.
            The same applies to the acupuncturist who comes here claiming to be able to e.g. correct a breech (fetal) presentation or soften the cervix of a full term pregnancy by placing a few thin needles in remote and unrelated anatomy. Such claims are met with utmost incredulity until proper evidence is produced. They are also met with scorn and disdain because everything we know about pregnancy and childbirth and the functions of the body contradict such ideas and playing such silly theatricals in the most sacred period of a person’s life is totally stupid – excuse my lack of subtlety.

            Those who have come here of late and gone on about Yin, Yang, Qi, the yellow emperor, energy meridians and other fantasy based phenomena that cannot be soberly observed or measured, have all had an equal opportunity to present their evidence here. They fail consistently to fulfill the basic requirements of credibility and adherence to facts of life and they have been told so in no uncertain terms.
            These people regularly resort to whining and complaining of a hostile and bullying atmosphere. Many of them soon disappear again, leaving scornful words.
            Some linger on and continue to whine and whimper and attack those who they perceive as their bullies instead of discussing the subject. They go for the man, not the ball, or go ‘ad hominem’ as we often call it.

          • Bjorn,

            “I could just as well have said: “You do not have to have to be involved in a car accident yourself to know all about how serious injuries it can cause.”

            Stop digging. Put down your shovel and quietly walk away.

          • are you sure that some victims of car-accidents would not have been offended?

        • @Keef

          “The problem with research into TCM acupuncture is there is no set protocol as each case is treated uniquely from the signs the patient presents.”

          The fact that there is nothing to physiologically distinguish an acupucture point from any other point on the body is more than a problem. It’s a science killer. A science degree in acupuncture is a nonsense until acupuncture points can be scientifically defined and demonstrated to exist.

          Well conducted methodologically robust clinical trials can work perfectly well to determine the efficacy of TCMA. Crappy trials, needless to say, can’t.

          For TCMA it is very easy to set up a suitable sham. Puncturing is necessary for acu-“puncture”, so a non-puncturing needle, successful patient blinding (should be checked for), sufficent power, will be revealing. This has been done. Acupuncture doesn’t work better than sham. Again, TCM acupuncture is committed to puncturing at specific points on the body. So again a sham is easy to arrange – puncture at a non-acupuncture point. This has been done. Acupuncture doesn’t work better than sham.

          That is the clinical problem with TCM acupunture.

          • @Leigh Jackson

            “The fact that there is nothing to physiologically distinguish an acupucture point from any other point on the body is more than a problem.”

            That certainly would be a problem. How do acupuncturists determine where to needle?

            “Puncturing is necessary for acu-“puncture”, so a non-puncturing needle, successful patient blinding (should be checked for), sufficent power, will be revealing.”

            How would a non-puncturing needle differ from acupressure?

          • @jm

            Non-puncturing shams prick the skin, and appear to be penetrating the flesh. Together these two factors appear to be good enough to do the trick. Good clinical trials will ask subjects afterwards whether subjects believed they received real or sham acupuncture. If both arms guess close to 50% each way, then blinding can be assumed to have worked – for acu-PUNCTURE.

            To test the efficacy of acupressure, one could test variations in pressure. For example, using an instrument to put a measured amount of pressure on the true treatment arm of the trial, and a much less amount of pressure for the other. Perhaps better in this case though, would be simply to test acupuncture points v non APs.

            I’m not that familiar with the evidence base for acupressure. I am very familiar with the evidence base for acupuncture. Acupuncture fails in high quality trials virtually 100%.

          • @Leigh

            “Non-puncturing shams prick the skin, and appear to be penetrating the flesh. Together these two factors appear to be good enough to do the trick.”

            Everything else being equal, that’s not really ‘sham’, but just different styles. One where needles are inserted, one where there’s just stimulation to the surface, at the point. Or certain acupressure styles, where a blunted tool is used. (That particular style of acupressure will certainly make it feel like a needle was inserted – more so than modern TCM needles. It will also feel like there’s a needle there, long after the pressure from the blunted instrument ended.)

            In my experience, each practitioner would expect their style to perform the best. But you could expect them to be in the same ballpark – which seems to be the case.

            “To test the efficacy of acupressure, one could test variations in pressure. For example, using an instrument to put a measured amount of pressure on the true treatment arm of the trial, and a much less amount of pressure for the other.”

            I don’t think that would get you what you’re after. For a treatment, pressure would vary point to point, side to side, patient to patient, day to day, etc. Most acupressure styles that I’ve heard of will vary the pressure while holding the point, as the tissue changes (to keep the same quality of engagement with the point).

            “Perhaps better in this case though, would be simply to test acupuncture points v non APs.”

            In my mind, that would be the way to go. But, it goes back to my earlier question: you said “The fact that there is nothing to physiologically distinguish an acupucture point from any other point on the body is more than a problem.”. How is the point location determined?

          • @jm

            “Everything else being equal, that’s not really ‘sham’, but just different styles.

            It’s certainly a sham for acupuncture defined as puncturing at particular points. According to that definition puncturing at non-acupuncture points should fail to produce the benefits that puncturing at acupuncture points is supposed to deliver.

            Point selection is a matter for individual practitioners; point location is defined by ancient tradition as far as I am aware.

            For purposes of RCTs, all that matters is that some points of the body are classed as acupuncture points and others not.

            You are defining acupuncture to be a form of acupressure. Puncturing is not therapeutically effective, pressure is.

            In which case why are needles ever used?

          • @Leigh

            Sorry. It sounded like you were talking about particular points being used on all patients studied – some treated with needles, some treated with non-puncturing needles. In which case, you could expect similar results.

            If you’re talking about the non-puncturing needle group being treated using ‘non-points’ – that would be different. But in that case, why not just use regular needles? If we had:

            Group A – needles at particular points
            Group B – non-puncturing needles at the same particular points
            Group C – treated with ‘non acupuncture points’

            What I was saying is that
            – I would expect similar results from groups A & B.
            – group B is actually receiving acupressure
            – group C, would it matter if they were getting puncturing or non-puncturing needles?

            In any case, you wouldn’t be studying an actual treatment from an acupuncturist, only the needling aspect. In addition to needling, an acupuncturist would use massage, gua sha, cupping, topical and internal herbs, exercises, etc – any, all, or none depending on the situation.

            Same with someone who practices acupressure. The only difference is that they wouldn’t puncture the skin.

            But as far as point location is concerned- yes, there are mapped out points. But you still have to find them on the body. A lot of beginners/students will measure based on charts and relational distances from point to point or body landmark to point. But that would be to get you in the ballpark – you then still have to palpate to find the exact point. The measurement aids are used until the student learns what points feel like.

            What I’m asking is – if there’s “nothing to physiologically distinguish”, how is the exact point located? I’m sure there’s an obvious answer…but for the life of me I can’t figure out what that would be.

          • @jm

            Your last comment is incomprehensible.

            I can only address your last paragraph. Until distinguishing histological properties of acupuncture points can be scientifically verified, acupuncturists can do no more than fish around the general vicinity marked on the map.

          • Leigh,

            Sorry you’re having a problem comprehending. I feel your pain. Here’s what I’m having a hard time comprehending. You said “TCM acupuncture is committed to puncturing at specific points on the body. So again a sham is easy to arrange – puncture at a non-acupuncture point. This has been done.”

            If they “do no more than fish around the general vicinity marked on the map”, how do you consider that “specific points on the body”?

            Seriously, how would one locate a specific point, by fishing around a general vicinity, with nothing to physiologically distinguish an acupucture point from any other point on the body?

          • One cannot locate a point on the body which is not found in any medical textbooks. Nor are there precise instructions given by TCM tradition, it would appear. Not a very satisfactory state of affairs – but this is alternative medicine after all.

            Nonetheless, acupuncturists believe they are capable of locating acupuncture points – and therefore, necessarily, locations which are not deemed to be APs.

            That’s all that’s required to do clinical trials.

            HQ clinical trials indicate acupuncturists are wrong in their beliefs.

            No difference is found between what acupuncturists claim to be non-APs and APs.

          • Leigh

            Thanks for that – it really does help understand some of the comments. I’m still not clear on what the purpose of non-puncturing needles would be, unless you were trying to compare acupuncture and acupressure. Non-puncturing needles on acupuncture points would not be sham acupuncture, if the goal is to do a clinical trial for treating a specific condition.

            “One cannot locate a point on the body which is not found in any medical textbooks. Nor are there precise instructions given by TCM tradition, it would appear. Not a very satisfactory state of affairs – but this is alternative medicine after all.”

            If that were true, I’d totally agree with you. But it’s not – the obvious example of points that aren’t found in medical textbooks would be Ah Shi points. (that’s just one example)

            And, point location instructions are very precise. You’ve been deceived by appearances :).

          • From what you said the method did not sound too precise. Something about “palpations” to find the exact spot. But if you say that in fact there are very precise instructions, fine, you could have made that clear before. You gave me the impression that it was not clear cut.

            I’ve no idea what Ah Shi points are but if they correspond precisely, histologically, with medical text books then well and good. Acupuncture points do not.

            I can’t make it any clearer when and why non-puncturing needles provide a perfectly sound sham.

          • Leigh

            You’re quite clear- you think acupressure (non-puncturing needles used on acupuncture points is acupressure) works as a perfectly sound sham for acupuncture. We disagree.

            Palpation means to examine a part of the body by touch. A chart will get you in the area, then you palpate – points have a particular feel that distinguishes them. Don’t take my word for it – go talk to an acupuncturist, they can show you. Or, I’m sure there’s a martial artist in your area that is familiar with acupuncture points, and would be happy to show you how to find them, what effect they can have on the body, and how the effect changes if you miss the point slightly.

            What I want to know is how you think points are found if there’s “nothing to physiologically distinguish” a point from anywhere else. What exactly do you think they “fishing around” for?

          • @jm

            This is clearly pointless. We are getting nowhere. You fail to understand me completely and I certainly struggle to understand you. I’m not going to struggle any more. Life is too short.

          • Leigh

            I understand you perfectly fine. And I suspect you understand that if the only difference in treatment is changing needles to non-puncturing needles, it isn’t ‘sham’ acupuncture.

            Unless the goal is to have ‘sham’ and acupuncture perform similarly, of course ;).

            Methinks you protest too much, Mr Skimpole.

            (extra points for the pun, though)

          • no name calling, please!

          • “[jm] if the only difference in treatment is changing needles to non-puncturing needles, it isn’t ‘sham’ acupuncture.”

            If the only difference in treatment is changing non-puncturing needles to needles, it doesn’t turn a sham treatment into an efficacious medical treatment.

          • @jm

            If you do understand me perfectly fine, then you are deliberately ignoring some and misrepresenting other parts of what I have said.

            I have no interest in googling “Mr Skimpole”. Whoever the character may be, the only point you score is one you are very welcome to. No pun intended.

          • Pete – So true! Not what we were talking about, but true nonetheless!

            Leigh – it’s a Bleak House (Dickens) reference.

    • Tom,

      Many / most / if not all, branches of alt-med continue to produce “significant new material” that suggests it is better than placebo.

      This “significant new material” has rendered irrelevant the question of whether or not a particular branch of the sCAM empire is better than placebo. It now serves to focus on the vitally important question that the sCAM empire refuses to address: the relative cost-benefit ratios and the risk-benefit ratios of each of its branches.

      Until the alt-med empire produces a robust evidence-based assessment of its plethora of treatment modalities for the plethora of conditions which it claims to treat, neither its practitioners nor its patients are able to make properly informed medical decisions.

      In my humble opinion, I think that acupuncture and homeopathy are similarly effective for a wide range of medical conditions; I also think that the risks of acupuncture are greater than the risks of homeopathy. Do you have any robust evidence that would either confirm or contradict my current opinion?

      • @Pete I think it’s a mistake to lump all CAM together as some kind of malevolent ’empire’ – to me this seems both inaccurate and slightly paranoid. I don’t have much interest in or knowledge about homeopathy, and there isn’t much chance that I’ll personally be diving into the research you suggest any time soon.

        I would say though that the analysis I linked to did discuss the area of cost-effectiveness in some detail (e.g. in chapter 5), including strengths and weaknesses of the current analysis, and suggestions for future studies. I certainly haven’t read the whole paper, nor do I pretend to be an expert in research (which is one reason I keep an eye on this blog), but this paper seems to be a step in the right direction to me.

  • @Bjorn

    Unfortunately I don’t have time at the moment to give your comments due attention, but I thank you for your intelligent input and civility (more than can be said for some around here). I will try to revisit this when the decks are a little clearer (we’ve just moved into a new house). If you lived locally, I’d be very happy to offer a series of free treatments (nothing more satisfying than converting a skeptic, which I’m happy to say I have managed to do on several occasions). If you’re not willing to give acupuncture a try, I’d suggest trying a good curcumin supplement if you haven’t already (liposomal or Longvida forms).

  • @Frank I’ve had just about enough of your taunts and jibes. When I work in my clinic, I surround myself with healing light, and channel that light through my chakras and into my patients via my needles. Often, The Ancients stand at my shoulder and guide my hand towards the optimum Yin Yang fields for me. They also whisper advice in my ears (although I don’t speak Chinese so I usually just nod).

    When I read your words, I find myself needing to activate that same protective field of light. The Ancients come to me at these times too, and I feel I should warn you that they are most displeased with your bad energy. According to Google Translate, they say you urgently need acupuncture needles in REN-1 Huiyin and DU-1 Changqiang before it’s too late.

    • @Tom

      As I have told you before, you have to learn to endure the jocular reactions of (most of) your fellow humans to gobbledygook of the kind that precedes your rather well placed scorn.
      Or was your suggestion of needling the REN-1 and DU-1 in Frank’s nether regions, a seriously suggested acupunctural therapy mode to prevent the Frank’s Po (Corporeal spirit) to escape through Po Men (the anal orifice)?

    • Bjorn,

      Tom’s point choices should be obvious. He’s trying to get access to Frank’s Baihui.

      • Jm, I think Tom provided us with a timely reminder of two of the April Fool’s acupuncture points.

        I’m sure that acupuncturists long-ago[1] figured out that all acupuncture points are just variations of the April Fool’s acupuncture point.

        [1] circa 24/7/365.

      • Pete,

        “I think Tom provided us with a timely reminder of two of the April Fool’s acupuncture points.”

        I’m pretty sure everyone has those points, not just Frank.

    • @Tom Kennedy on Saturday 01 April 2017 at 21:45

      Nothing you do surprises me. I’m surprised you don’t use the sunshine from your rear orifice for a tanning clinic. At least it would have a use because its former use has been assumed by your nutrition intake orifice.

      • @Frank now there’s an idea, thanks for the business tip!

        You haven’t elaborated on your rather sweeping statements about my website. Out of interest, what do you think would happen to the average person should they follow some or all of the advice on my ‘resources’ page (which you linked to)?

        You also declined to elaborate on your own credentials – I’m just interested in what background has lead to so much Liver Yang rising? I’m just winding you up – but seriously, chill out man, you’ll do yourself an injury!

  • Bjorn Geir Leifsson (M.D.): strokes with one hand; strikes with the other.

  • A friend of mine (anesthesist) was visiting a course in a Chinese hospital to receive a license in acupuncture from the Peoples Republic of China.

    The Chinese doctors told the audience that they will do surgery with a pain-management via needles only.

    During the pause they looked after the patient and found a hidden peridural / PDA …

    So what might scholars do after such a training without knowing this fraud?

  • +my own experience is that in reality, the problem lies not with acupuncture, but with acupuncturists. every acupuncturist I have ever encountered wants to assert themselves as my spiritual advisor. not one has managed to internalize the basic principles of their medicine, so I find this to be exceedingly ironic. And so, by extention, whatever good they accomplish is short-lived, while the negative effects of being needled by a seemingly endless parade of arrogant demi-gods and goddesses linger forever, presumably as a way of bringing you back again and again, addicted to the endorphins perhaps?…. and many do hesitate to prescribe herbs, because they cure, but the profit ends there. these people generally speaking are so incredibly intolerant of Catholics, and Christians in general, that I have come to the general conclusion that most of them are demonicly possessed. I have observed scores of these folks, professors, students, and practitioners alike. I do exorcism prayers in the their offices and waiting rooms and watch their eyes flip and roll; their energy fields are mired, stuck, and heavily repressed. I suffered at their hands, because although they have their degrees, etc. they are simply not spiritually qualified to be needling vulnerable people. and I also lost a lot of money, but it was the price I had to pay, for my knowledge of demonology has increased ten-fold. It’s great that life provided me with all the lessons I needed to learn to become an exorcist, which has always been my goal. Thankyou to all of the amazingly deluded ‘healers’ who helped me on my path to liberate you! Of course, I never get acupuncture anymore and I encourage everyone to do the same. peace and love

    • ‘…most of them are demonically possessed’.

      Well, at least that’s an accusation I haven’t had on this site before! Hopefully an interesting debate will follow about the placebo controlled trials that back up your assertion 😉

  • There are no placebo controlled trials for assertions and accusations silly. Have anything interesting to say, as an acupuncturist, or are you a mindless protector of your livelihood and colleagues? Did I see death threats over threatened livelihoods somewhere in this commentary thread? Sounds like five element theory in action, to me! yeah, infighting, nasty barbs, the whole nine yards! Just the kind of folks a sick person wants to have needling their accupunture points! Perhaps, it is a matter of demonic infestation of the entire self-described priestclass called ‘the accupuncture community.’

  • Sorry Tom, I wouldn’t want to do that. Once I had an acupuncturist from China. (in 2010) He was a jewel of a man, with a heart of solid gold. (metaphorically speaking). He took my pulse and was able to determine when and why and how I first became ill. There is a term for that capacity, and I’m am sure you know what it is. This Dr. was an outliar to be sure. He cared so much about me and went to great extremes to help me. At the time, I was so sick I couldn’t take herbs, and most food made me ill. The man died at the hands of his hyper-competitive and extremely jealous colleagues. This is a very long story that I would only share with you personally. My dear friend, I do not mean to cast aspersions your way, since I do not know you. But I am speaking from my direct experience and I stand by my words….

  • THEM- as in “by their fruits you will know them”. Time will always tell.

  • @Lori: very interesting: “he took my pulse and was able to determine when and why and how I first became ill”.
    It’s coincidental I’m sure, but I had a secretary once who could put her hand on my inner thigh, put her tongue in my ear and tell when I first became interested in cheating on my wife. Amazing.

  • Why do you say that you think something is interesting when in fact, it’s sounds like the entire field is out of your depth (no pun intended!) … as well as your ability to make coherent analogies! Pulse diagnosis is a science as well as an art. Tom, Help! what’s the term so as to convince our fellow traveler?

  • Yes pulse-diagnosis is a REAL science, as is Chiropractic, Scientology, pick-up-sticks, and seduction. The term for that in case Tom can’t pull it from his ass, is fraud. My analogy was not only coherent but perspicacious, as my secretary (just as your acupuncturist) were intent on screwing us…..mine literally yours figuratively.
    Perhaps it’s you that has gone off the deep end and come up with the bends?

  • I told you I don’t go to acupuncturists anymore. Perhaps they are little hogs feeding at the trough of the insurance companies. the men were always coming on to me . twisted little powermongers at the very least! I repeat, the only good one I ever had is dead. literally. someday i’ll write my novel. tom can’t come up with the term, how sad….

  • I’ve had some masterful cold readings done by acupuncturists. The psychic parlour games, combined with a hodgepodge of half-baked Jungian shadow projections, massive unchecked egos, and new age thought, combined with a deeply ingrained, self-serving bourgeois value system make it all a force to be reckoned with, I suppose….yeah…..
    Michael , you are spot on. They nearly killed me and took all of my money. I guess it would be fairly safe to say I learned the absolute hard way. I was spiritually sodomized in no uncertain terms….

  • end of discussion. the field is demonically invested, ha h ah ha….I mean INFESTED!!!

  • shit for shen arrogant new age shadow puppets, you’ve all crawled back under your rocks. well, needle on , you mindless devils!

  • as a person who has actually done acupuncture, it has most definitely helped with not only my back pain but my anxiety. it has been around for thousands of years and i truly believe it can help

    • I am sure you do – but belief can be misguided.
      I prefer evidence.

    • as a person who has actually done acupuncture, it has most definitely helped with not only my back pain but my anxiety.

      I have suffered for years with backpain from a very young age (as in: about 8 to 9 years old) and it stopped when I was around 35/36 years old. Guess what therapy I received for it?

      it has been around for thousands of years

      I have heard this claim for almost five decades. I would be grateful if you could provide some solid evidence for this as I have never been able to find it.

      and i truly believe it can help

      I don’t doubt that, but ‘belief’ isn’t much to go on, is it?

  • https://www.sciencenews.org/blog/context/evidence-based-medicine-actually-isnt

    Markedly more indiciduals suffer at the hands of allotpathy every year: johns hopkins estimates 250,000 per year based on “medical error”

    You should be more aftaid of your primary care doctor than an acupuncturist with proper training

    Improper prescriptions, medical malpractice, downright ignorance and hubris.
    “Do no harm” to the hand that feeds you (read big pharma)

    https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

    • WE HAVE DISCUSSED THESE ISSUES SO OFTEN, THAT I DO NOT WANT TO REPEAT MYSELF YET AGAIN
      http://edzardernst.com/2018/06/first-do-no-harm-what-does-it-mean-how-does-it-apply-to-alternative-medicine/

      • Point taken “do no harm”

        However, you completely ignore the 200:1 ratio of fatalities
        Western med: Acupuncture

        Suffice it to say, inappropriately trained and practicing medical practitioners
        Are the problem, and consider Allopaths “medical error” deaths
        may now surpass some forms of cancer as leading cause of death!

        https://www.hopkinsmedicine.org/news/media/releases/study_suggests_medical_errors_now_third_leading_cause_of_death_in_the_us

        Your empiricist view point is moot

        • Dear Sandy,
          it seems that you have not understood the message.
          I do not know if the statistic that you mention (200:1 ratio of fatalities Western med: Acupuncture) is correct or not. But even if your comment would be true that “(…) inappropriately trained and practicing medical practitioners Are the problem”, then the answers must be:
          *IMPROVE THE TRAINING/EDUCATION of the evidence-based medical practitioners
          *SUPPORT SERIOUS SCIENTIFIC RESEARCH on health issues.

          The answer CANNOT be to promote CAM (homeopathy, acupunture, TCM, etc. etc.) which:
          *Contradict science & logic
          *Have no prooven positive effect (beyond placebo, which is not reliable)
          *Involve serious risks (at the very least, delay of an effective treatment. Wost case as mentioned in this blog: death).

          BTW, the statement to fist “do no harm” is NOT correct, because many necessary treatments first do harm (e.g. in all cases of surgery). The important thing is that the benefit must outweigh the “harm”, i.e. the ratio of benefit vs. risk must be positive to promote a treatment. For acupuncture (and all other CAM), this ration is negative, because clinical RCT studies show that it just does not work efficiently (beyond placebo, that is).

    • We seem to have yet another gullible reader of Gary Null, Natural News, Mercola and similar fake-information dumps designed to scare people to buy snake-oil.
      Here is a good response to the common fallacy about murderous medical doctors: https://sciencebasedmedicine.org/death-by-medicine/

      The most important issue is that modern medicine saves fantastically more lives and so called alternative medicine cannot replace medicine, not more than flying carpets can replace aeroplanes.

  • These are some spicy comments haha

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