Whenever a journalist wants to discuss the subject of acupuncture with me, he or she will inevitably ask one question:
DOES ACUPUNCTURE WORK?
It seems a legitimate, obvious and simple question, particularly during ‘Acupuncture Awareness Week‘, and I have heard it hundreds of times. Why then do I hesitate to answer it?
Journalists – like most of us – would like a straight answer, like YES or NO. But straight answers are in short supply, particularly when we are talking about acupuncture.
Let me explain.
Acupuncture is part of ‘Traditional Chinese Medicine’ (TCM). It is said to re-balance the life forces that determine our health. As such it is seen as a panacea, a treatment for all ills. Therefore, the question, does it work?, ought to be more specific: does it work for pain, obesity, fatigue, hair-loss, addiction, anxiety, ADHA, depression, asthma, old age, etc.etc. As we are dealing with virtually thousands of ills, the question, does it work?, quickly explodes into thousands of more specific questions.
But that’s not all!
The question, does acupuncture work?, assumes that we are talking about one therapy. Yet, there are dozens of different acupuncture traditions and sites:
- body acupuncture,
- ear acupuncture,
- tongue acupuncture,
- scalp acupuncture,
- etc., etc.
Then there are dozens of different ways to stimulate acupuncture points:
- needle acupuncture,
- electroacupuncture,
- acupressure,
- moxibustion,
- ultrasound acupuncture,
- laser acupuncture,
- etc., etc.
And then there are, of course, different acupuncture ‘philosophies’ or cultures:
- TCM,
- ‘Western’ acupuncture,
- Korean acupuncture,
- Japanese acupuncture,
- etc., etc.
If we multiply these different options, we surely arrive at thousands of different variations of acupuncture being used for thousands of different conditions.
But this is still not all!
To answer the question, does it work?, we today have easily around 10 000 clinical trials. One might therefore think that, despite the mentioned complexity, we might find several conclusive answers for the more specific questions. But there are very significant obstacles that are in our way:
- most acupuncture trials are of lousy quality;
- most were conducted by lousy researchers who merely aim at showing that acupuncture works rather that testing whether it is effective;
- most originate from China and are published in Chinese which means that most of us cannot access them;
- they get nevertheless included in many of the systematic reviews that are currently being published without non-Chinese speakers ever being able to scrutinise them;
- TCM is a hugely important export article for China which means that political influence is abundant;
- several investigators have noted that virtually 100% of Chinese acupuncture trials report positive results regardless of the condition that is being targeted;
- it has been reported that about 80% of studies emerging from China are fabricated.
Now, I think you understand why I hesitate every time a journalist asks me:
DOES ACUPUNCTURE WORK?
Most journalists do not have the patience to listen to all the complexity this question evokes. Many do not have the intellectual capacity to comprehend an exhaustive reply. But all want to hear a simple and conclusive answer.
So, what do I say in this situation?
Usually, I respond that the answer would depend on who one asks. An acupuncturist is likely to say: YES, OF COURSE, IT DOES! An less biased expert might reply:
IT’S COMPLEX, BUT THE MOST RELIABLE EVIDENCE IS FAR FROM CONVINCING.
5 Responses to The question to ask during ‘Acupuncture Awareness Week’: DOES ACUPUNCTURE WORK?
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A journalist who asks “Does acupuncture work?” Should be asked: “Please define your terms.”
‘Acupuncture’ by definition requires puncture of the epidermis at least, by a needle (Latin: ‘acus’.).
Given the Greek for a surgeon’s needle is ‘balone’, the technique might be more aptly named ‘Balonetherapy’.
As for ‘work’ – the answer is “Yes”.
Balonetherapy works to provide satisfaction to the gullible (who are often vulnerable); income for charlatans; psychological support to the needy; TLC for those who cannot obtain it elsewhere and the (temporary) benefits of the response expectancies of theatrical placebo.
Does it ‘work’ to have an effect on any pathological process?
“No – there is no evidence of such working.”
I used acupuncture in General practice for a while. The patients just loved being told to relax in a small dark room for 30 mins. I used less and less needles as it seemed to me that the thing that made the difference was just having a rare bit of ‘time out’ I ended up just using one needle, as just telling them to lie quietly for half an hour with nothing might have seemed a bit odd. Then I had to realise there were better ways of using my time and appointments.
not an uncommon course of events.
And yet Medicare and private insurance in the US must cover it for certain things–back pain for one. Chiropractic as well. Thanks to letting ignorant congresspersons legislate medicine. Same goes for Naturopathy, alas. Millions have no insurance, millions more cannot access care due to insane deductibles and copays, but pseudomedicine is covered. Drugstores are full of homeopathy on the same shelf as real remedies and huge amounts of floor space at Costco, et al, are dedicated to useless supplements all making outrageous claims that are justified by government due to tiny print FDA disclaimer.
If acupuncture actually did work, the best designed and most reliably performed studies would inevitably demonstrate at least some efficacy. That is not the fact. As for any non-effective remedy, the better the study, the less likely it is to show any effect.
It requires intricate ‘trickery’ to perform reliably blinded trials of such a physically invasive procedure as puncturing the skin with a needle, unless one can find subjects that are naturally “blind” to the procedure.
That is exactly what Norwegian general practitioner Holgeir Skejeie did. He was genuinely interested in acupuncture as well as clinical research so he set out with testing what may be the best subjects for a blinded trial of acupuncture, i.e. colicky infants.
He simply took them away from their parents while they were being randomly punctured (or not) and then returned them all with an identical piece of plaster. The result? –
Dr. Skjeie even went to China (Shanghai) to see if they punctured children over there. They did not. At least very rarely.
And he did a systematic review finding that
(Whatever “on a general basis”means?)
The only finding from this mishandling of infants was that the punctured children cried more during the procedure than the more fortunate placebo group.
More research is NOT needed.
Dr. Skjeie has also studied acupuncture for back pain, without demonstrating that it works.
Dr. Skjeie‘s page at Olso University, where you can find references to his research: https://www.med.uio.no/helsam/english/people/aca/holgers/