MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

The most frequent of all potentially serious adverse events of acupuncture is pneumothorax. It happens when an acupuncture needle penetrates the lungs which subsequently deflate. The pulmonary collapse can be partial or complete as well as one or two sided. This new case-report shows just how serious a pneumothorax can be.

A 52-year-old man underwent acupuncture and cupping treatment at an illegal Chinese medicine clinic for neck and back discomfort. Multiple 0.25 mm × 75 mm needles were utilized and the acupuncture points were located in the middle and on both sides of the upper back and the middle of the lower back. He was admitted to hospital with severe dyspnoea about 30 hours later. On admission, the patient was lucid, was gasping, had apnoea and low respiratory murmur, accompanied by some wheeze in both sides of the lungs. Because of the respiratory difficulty, the patient could hardly speak. After primary physical examination, he was suspected of having a foreign body airway obstruction. Around 30 minutes after admission, the patient suddenly became unconscious and died despite attempts of cardiopulmonary resuscitation.

Whole-body post-mortem computed tomography of the victim revealed the collapse of the both lungs and mediastinal compression, which were also confirmed by autopsy. More than 20 pinprick injuries were found on the skin of the upper and lower back in which multiple pinpricks were located on the body surface projection of the lungs. The cause of death was determined as acute respiratory and circulatory failure due to acupuncture-induced bilateral tension pneumothorax.

The authors caution that acupuncture-induced tension pneumothorax is rare and should be recognized by forensic pathologists. Postmortem computed tomography can be used to detect and accurately evaluate the severity of pneumothorax before autopsy and can play a supporting role in determining the cause of death.

The authors mention that pneumothorax is the most frequent but by no means the only serious complication of acupuncture. Other adverse events include:

  • central nervous system injury,
  • infection,
  • epidural haematoma,
  • subarachnoid haemorrhage,
  • cardiac tamponade,
  • gallbladder perforation,
  • hepatitis.

No other possible lung diseases that may lead to bilateral spontaneous pneumothorax were found. The needles used in the case left tiny perforations in the victim’s lungs. A small amount of air continued to slowly enter the chest cavities over a long period. The victim possibly tolerated the mild discomfort and did not pay attention when early symptoms appeared. It took 30 hours to develop into symptoms of a severe pneumothorax, and then the victim was sent to the hospital. There he was misdiagnosed, not adequately treated and thus died. I applaud the authors for nevertheless publishing this case-report.

This case occurred in China. Acupuncturists might argue that such things would not happen in Western countries where acupuncturists are fully trained and aware of the danger. They would be mistaken – and alarmingly, there is no surveillance system that could tell us how often serious complications occur.

29 Responses to Death by acupuncture

  • This is quite shocking, not least because of the poor care given when the patient was seen in Casualty. Tension pneumothorax is not particularly difficult to diagnose clinically, and indeed it should have been obvious during CPR from the stiffness of the chest and the difficulty with ventilating the patient. It is a recognised complication of many other lung diseases and should always be considered in a patient presenting with acute shortness of breath. Inserting an ordinary IV cannula through the skin into the chest cavity would have given immediate relief and saved his life.

    A quick internet search on acupuncture-related injury brought up this paper https://www.who.int/bulletin/volumes/88/12/10-076737/en/ which I found very interesting even before I realised that you were a co-author. I hadn’t realised how deep acupunture needles can go, nor that acupuncturists’ knowledge of anatomy could be so poor. It seems that careful palpation by an experienced practitioner can identify energy flows in order to locate the correct acupuncture point, but can’t identify a beating heart.

    I wonder how many such injuries go undiagnosed. Unless the needle goes straight into a major artery, any organ damage is likely to take a few days at the very least to reveal itself. Ditto infection, particularly something like Hepatitis B, which requires only a small amount of contamination of a needle to cause an infection (in contrast to HIV, which is much less infectious).

  • I remember many years ago homeopathy’s pet imbecile Dana Ullman putting a post on Twitter abut acupuncture being a harmless therapy. I replied with links to lots of stories like this. He replied that these were obviously not properly-qualified therapists. I pointed out the use of the No True Scotsman logical fallacy. He blocked me.

  • Thank you Ernst for pointing out this case report. This should be required study material for anyone that is a student at the Oriental Medicine academies or are acupuncturists themselves. I know when I studied acupuncture the risks for pneumothorax was well known and students were closely monitored when doing their labs.

    However this report and other risks that you have identified do not take away for the effectiveness of acupuncture. As with all medicine treatment modalities, the proper diagnosis and relevant treatment based on that diagnosis together with the expert management of that treatment is key in order to either minimize complaints or curing the disease.

  • “Acupuncture” from Latin: acus, a needle.

    I don’t know what the Chinese call it, but why don’t we use the Greek?

    Greek: belone, a needle.

    “Belonethreapy” is so much more apposite and would improve patients’ ability to give informed consent!

    • too close to baloney ???

      • Like the medical secretary whotyped in a letter that a patient had had a baloney amputation?

        • The patient tried to sue about the error but they didn’t have a leg to stand on.

          • I have also heard a secretary ask “who is this Sir Vikal Smears, and how do you spell his name?”, and seen a pathology report referring to a square mouse cell carcinoma. Also the first time I ever tried to request an NMR scan (now called MRI) the receptionist asked, “Do you mean a barium enema?”.

            But the worst one was a report on a chest x-ray, which simply said “Heart and lung fields: No chance”. It was clipped to the outside of the film packet and given to the patient to take back to the ward. He took a lot of convincing when I tried to explain that at was quite usual for a report to say “No change”.

  • My wife, a nurse, is Mrs A Law. Numerous times people have seen her name on documents and thought it’s something to do with MRSA Law.

  • I’ve been treating patients as a licensed acupuncturist in NY for more than 30 years. Never have myself or any of my 100+ colleagues have caused a pneumothorax from an acupuncture needle. Countless patients are harmed annually from MD screw ups than from a licensed acupuncturist. In fact, more organizations (NIH, WHO, American Medical Assoc., etc…) recommend and people today turn to Chinese Medicine because Western Medicine have let them down. We help patients get well, especially in the midst of the current opioid crisis, which was created and perpetuated by Western medicine. You want stats? Happy to provide. Better yet, why don’t you all get educated and get a treatment? Willing to bet not many people on this blog have ever been treated. But you’re quick to judge. Perhaps deep down you feel threatened by this successful medicine. I would be, too. I’m also a MD.

    • “I’m also a MD”
      You don’t seem to be able to write grammatical English, to the extent that I am not even clear what you are trying to say. Nor do you seem to be terribly well-informed. I would expect a doctor to be better educated and to have the training to think critically. Are you really what you say you are?

      Dr Julian Money-Kyrle MA MBBS MRCP FRCR (GMC No. 3180734, retired Clinical Oncologist)

    • So, Sheila, what’s your argument? That you’ve not seen – and none of your 100+ colleagues have told you they’ve seen – a pneumothorax, therefore they never happen?

      You want stats? Happy to provide.

      Evidence for everything you claim would be good. Ta.

      • my grandma smoked 2 packets of cigarettes per day and never died of lung cancer; conclusion: cigarettes do not cause lung cancer?

      • “… therefore they never happen?”

        Yes Alan, I’m sure that’s exactly her point.

        I’ve heard the same thing from lots of other acupuncturists, but their point is that it’s really rare. So rare, that even on this site the example used is the pheumothorax caused by a massage therapist in Canada in 2013.

        But obviously, Sheila is saying that her experience is hard evidence. Edzard’s cigarette/lung cancer comment is proof of that.

        • But how rare? Perhaps Sheila can tell us…

        • What do you mean by “rare”?
          What incidence is needed before something is not considered rare?

          Let’s have a look at the situation in my corner of the world, the nordic countries.

          In Denmark (Pop. 5.9 million, about 1.3 thousand regulated acupuncturists) a death occurred due to bilateral pneumothorax in the summer of 2017. Due to the attention this catastrophe raised, reports appeared of three more in the same period, two of them minors. It was concluded that this complication is severely underreported. (https://bit.ly/2D5Rg69)
          The Danish agency for patient safety issued a warning about the perils of acupuncture-pneumothorax. (https://bit.ly/2TLrKZo)

          In tiny Iceland (Pop. 0.34 million) a woman was in immediate danger due to bilateral pneumothorax last spring. She was being needled for nausea of pregnancy.
          (https://bit.ly/2TPvXeV)
          This case was reported by the hospital but I have found more cases that were never reported (ongoing work) There are anecdotes of cases that did not tell about the preceding acupuncture when admitted for pneumothorax.
          Two cases I found had been caused by the same physiotherapist.

          Is it perhaps safe to stick somewhere else, just not in the chest?
          No, it is not totally risk free to stick needles anywhere in the body.
          In Norway (pop. 5.3 million) a 64 year old man died in 2016 due to sepsis from an infection in the hand caused by acupuncture at a teaching institute! They tried in vain to save him with an amputation. (https://bit.ly/2HaEzLD)
          Media in Scandinavia regularly flare up with news of acupuncture risks. Here is an example from 2011 of a girl in Norway with pneumothorax after AP. (https://bit.ly/2VLRnew)
          That year there was considerable media attention about the risks of AP.

          It is clear that there is grave underreporting of serious adverse events from acupuncture and “dry needling”.

          Every time this discussion comes up, acupuncturists and physiotherapists cry out in rage to defend their livelihood and their pride.

          Now, someone might think that the benefit of acupuncture justifies a slight risk, right? The risk is even worse in dry-needling as a deep infection in a muscle or fasciae may prove more serious. (E.g.: https://bit.ly/2QJSPu2)

          OK, let’s examine the evidence for benefit from acupuncture. Here are more than sixty Cochrane reviews on acupuncture for different indications. Look for yourselves (try to read the reports linked, not just this list:

          https://bit.ly/2VMLnSS

          How many of these reviews report undoubtable benefit? – none!
          There is an optimistic conclusion in some (written by enthusiasts?) and a couple show a small, insignificant effect over placebo/sham.
          Considering that modern acupuncture has no demonstrated mechanism of action and the knowledge base is extremely incoherent and unsupported, one cannot but conclude that any benefits are conspicuous only by their absence and implausibility.
          This means the risk/benefit ratio approaches infinity.

          If acupuncture were a drug it would very likely have been pulled off the market some time ago.
          Vioxx worked fine for its purpose as an NSAID. Its risk/benefit ratio was however considered unacceptable, even if it is far far better than that of acupuncture, which does not show any credible independent efficacy and carries serious (albeit “rare”, if you insist on calling them that) risks.

          • “What do you mean by “rare”?”

            “Very uncommon.” If you have a handful of case examples…with at least 2 of them from physiotherapists (pts aren’t acupuncturists)…I’d say that qualifies as very uncommon. And what do you mean by rare?

            “It is clear that there is grave underreporting of serious adverse events from acupuncture and “dry needling”.”

            Sounds like a problem that could be easily fixed by hospital bookkeeping. Are you doing anything to solve the problem?

          • the problem is that of acupuncture! why should hospital doctors fix it.
            and anyway, a pneumothorax can remain undiagnosed and heal without ever be seen by a doctor.

          • “the problem is that of acupuncture! why should hospital doctors fix it.”

            Hospital doctors are doctors – if they can do something as straightforward as reporting acupuncture induced pneumothorax, and it helps patients…why would they not do that? If hospital doctors were seeing a lot of patients with carbon monoxide poisoning, I would hope they would inform the gas company.

            “and anyway, a pneumothorax can remain undiagnosed and heal without ever be seen by a doctor.”

            Your post is “death by acupuncture”. A pneumothorax that heals on its own doesn’t really fit the whole “death” thing. Different topic.

          • 1) why would they not do that?
            BECAUSE THEY HAVE QUITE A BIT OF OTHER THINGS TO DO
            2) I was answering to you comment which was about pneumothorax, not death by pneumothorax

          • Seems like helping patients should be at the top of the list. Since there’s “grave underreporting”, maybe the “BIT OF OTHER THINGS TO DO” should be re-evaluated. “Grave” implies that it’s a pretty serious situation.

Leave a Reply

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

If you want to be able to edit your comment for five minutes after you first submit it, you will need to tick the box: “Save my name, email, and website in this browser for the next time I comment.”
Recent Comments

Note that comments can be edited for up to five minutes after they are first submitted but you must tick the box: “Save my name, email, and website in this browser for the next time I comment.”

The most recent comments from all posts can be seen here.

Archives
Categories