acupuncture
So-called alternative medicine (SCAM) likes to present itself as a champion of disease prevention. Its advocates routinely claim to promote health before disease develops, to strengthen the body’s defences, and to address root causes rather than symptoms. This rhetoric is highly attractive, because prevention sounds proactive, humane, and economical. Crucially, it is also good for the SCAM practitioner’s bank account. Yet there is a snag: almost none of the preventive claims made for SCAM are supported by reliable evidence, whereas the prevention that works comes overwhelmingly from conventional medicine and science.
To show preventive benefit, an intervention must demonstrably reduce the incidence of symptom, disease, complication, or mortality in properly designed studies. That may require randomised trials, epidemiological studies, large cohorts, reproducible findings, and enough follow-up to show that fewer people actually experienced the given endpoint. Mainstream medicine has repeatedly met this standard. Immunization, blood pressure control, smoking cessation, lipid lowering, cancer screening, and risk-factor modification are all products of biomedical research, not of alternative healing traditions.
SCAM, by contrast, tends to use prevention in a loose, impressionistic, and unfalsifiable way. A practitioner may claim that a treatment “balances energy,” “supports immunity,” or “keeps the body in harmony,” but such phrases do not establish a preventive effect. They are placeholders for evidence, not evidence itself. In practice, the absence of disease after treatment is treated as proof that the treatment worked, even though the same outcome occurs every day without any intervention at all.
Acupuncture is a good example. Its defenders portray it as a preventive system capable of preserving general health or warding off illness, but the evidence base does not support that claim. Some reviews do suggest that acupuncture may help with some pain-related and symptom-focused conditions, yet its preventive value is largely unproven. I am not aware of solid evidence to show that acupuncture prevents anything – but, if I am wrong, please do correct me.
Chiropractic care is even more revealing because preventive claims are often tied to the doctrine of spinal “subluxation” and nervous system dysfunction. Yet the literature on prevention is thin and methodologically weak. I am not aware of solid evidence to show that chiropractic prevents anything – but, if I am wrong, please do correct me.
Herbalism benefits from the romantic appeal of “natural” remedies, but that appeal should not be confused with demonstrated preventive efficacy. Individual plant compounds have certainly inspired real drugs, yet that is a triumph of pharmacology, not of herbalism as a system. When herbal medicines are tested for prevention, results are usually weak, inconsistent, or insufficient to support recommendation. I am not aware of solid evidence to show that herbal medicine prevents anything – but, if I am wrong, please do correct me.
Homeopathy is one of the most extreme cases within SCAM. It is often sold as gentle, individualized, and even preventive, but its basic principles are scientifically implausible, and its clinical evidence is either flawed or negative. Preventive homeopathy, including ideas such as “homeoprophylaxis,” is particularly problematic because it can give people a false sense of security while displacing interventions that genuinely prevent disease, such as vaccination. I am not aware of solid evidence to show that homeopathy prevents anything – but, if I am wrong, please do correct me.
SCAM speaks almost constantly about prevention, but the evidence for actual preventive benefit is close to non-existent. What we know about prevention, what truly reduces disease incidence and improves population health, comes from conventional medicine, epidemiology, public health, and biological science. SCAM will no doubt continue to borrow the language of medicine and prevention, but – as far as I can see – it has failed to supply the proof.
Needle-based acupuncture is used in some detoxification settings. However, its efficacy for illicit drug use disorders remains uncertain because prior reviews often mixed comparator types, co-interventions, or non-needle modalities. This review aimed to evaluate needle-based acupuncture monotherapy using comparator-stratified meta-analysis.
The authors searched PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM/SinoMed, trial registries, and supplementary sources from inception to September 12, 2025. The quantitative synthesis was restricted to randomized trials of manual acupuncture, electroacupuncture, or needle-insertion auricular acupuncture delivered without concomitant pharmacotherapy or psychotherapy. Although the registered protocol allowed non-randomized comparative studies, none were pooled because of insufficient comparability and a higher risk of confounding. Sensitivity analyses excluded trials with moxibustion co-treatment.
Thirteen randomized trials (n = 1,027) were included in the meta-analysis. For the prespecified primary outcome of withdrawal severity at the end of treatment, acupuncture favored blank/no-acupuncture controls [g = −2.089, 95% confidence interval (CI): −2.869 to −1.309; τ² = 0.712; I² = 82.9%], but the prediction interval (PI) crossed the null (PI: −4.306 to 0.128). Against active non-acupuncture comparators, the pooled effect was imprecise (g = −1.70, 95% CI: −5.43 to 2.02; PI: −23.49 to 20.09). Against sham acupuncture, two comparisons yielded an imprecise estimate (g = −1.45, 95% CI −9.41 to 6.51), and no PI was estimated. Among secondary outcomes, anxiety favored acupuncture over blank/no-acupuncture controls (g = −1.537, 95% CI: −2.047 to −1.026; PI: −2.939 to −0.134), whereas evidence from sham-controlled studies was less certain (g = −0.998, 95% CI: −1.744 to −0.252; PI: −2.828 to 0.832). For depression outcomes, PIs crossed the null in both blank- and sham-controlled analyses. The certainty of the evidence was low to very low.
The authors concluded that acupuncture exhibited favorable average effects on withdrawal severity, but null-crossing PIs limited confidence in the reproducibility of these effects across different settings and treatment protocols. Anxiety was interpreted as a secondary finding. No serious acupuncture-related adverse events were explicitly reported, although surveillance was often passive or insufficiently described.
The review treats acupuncture as “effective” for illicit drug disorders by highlighting short-term improvements in craving or anxiety, while the outcomes that matter for addiction – abstinence, relapse, use frequency, and retention – show no reliable benefit.
This, I think, is a classic case of presenting a negative result as a positive finding!
The review explicitly found no consistent difference between acupuncture and comparators for substance use endpoints, and the apparent positive outcomes were limited by low-quality evidence and publication bias. By foregrounding surrogate outcomes and obscuring the lack of clinically decisive effects, the paper misleads readers into perceiving acupuncture as a viable monotherapy for drug use disorders. Yet the evidence does clearly not support that conclusion.
Postherpetic neuralgia (PHN) is a refractory neuropathic pain condition with limited therapeutic options. Although electroacupuncture has demonstrated potential analgesic effects, high-quality evidence from rigorous randomized clinical trials remains limited.
This multicenter, randomized, sham-controlled clinical trial determined whether electroacupuncture reduces pain severity compared with sham electroacupuncture and evaluated its safety in patients with PHN. It took place at 7 tertiary hospitals in China and enrolled participants from October 2020 to July 2022, with the last follow-up in September 2022. Data analyses were performed from August to December 2025. Participants with PHN aged 45 to 75 years and moderate to severe pain (11-point Numeric Rating Scale [NRS-11] score ≥4) were recruited. Of 1072 patients screened, 624 were excluded. The remaining 448 participants were randomized to electroacupuncture (n = 225) or sham electroacupuncture (n = 223); 383 participants (85.49%) completed the trial. Patients received 20 sessions of electroacupuncture or sham electroacupuncture over 4 weeks, followed by a 4-week posttreatment follow-up. The primary outcome was the change in the NRS-11 scores from baseline to week 4, with responders defined as participants achieving a 30% or more reduction in NRS-11 scores.
Of 448 participants, the mean (SD) age was 63.19 (9.26) years, 233 (52.01%) were male, and 215 were female (47.99%). At week 4, the electroacupuncture group had a greater decrease in the NRS-11 scores (−1.52) than the sham electroacupuncture group (−0.99) with an adjusted mean difference of −0.53 (95% CI, −0.61 to −0.43; P < .001), and the responder rate was significantly higher in the electroacupuncture group (46.68%) than in the sham electroacupuncture group (24.28%) (adjusted risk difference, 22.40%; 95% CI, 13.02%-31.79%; P < .001). These treatment benefits persisted through a 1-month follow-up; no clinically significant adverse events were observed.
The authors concluded that, among patients with PHN in this study, electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes. These benefits suggest that electroacupuncture may be a useful nonpharmacological option for integrated management of PHN.
Here are a few points of concern and criticism:
- The authors state that the study was funded by the Evidence-Based Capacity Building Project for Traditional Chinese Medicine from National Administration of Traditional Chinese Medicine, the National Natural Science Foundation of China, the Natural Science Foundation of Jiangsu Province, Young Elite Scientists Sponsorship Program by China Association of Chinese Medicine, Youth Talent Project of Jiangsu Province Administration of Traditional Chinese Medicine, and Nanjing University of Chinese Medicine Double-Hundred Talent Program. Yet, they insist they had no conflict of interest.
- Acupuncture studies from China are as good as never negative. As frequently noted on this blog, the vast majority of Chinese studies seem to rely on falsified data.
- The authors imply that their study was patient-blind; yet there is no way that this is true: 1) The verum was administered to elicit ‘de-qi’, while the sham was not. 2) The electrical current in the verum group induced mild muscle twitching, while the sham group had no such experience. This means the verum patients knew the were receiving verum and thus were expecting an effective therapy. By contrast, the control group would have comprehended that they were given a placebo and were disappointed. These effects inevitably contribute to the outcome. In fact, I would agruge that they suffice in bringing them about without any contribution of a specific acupuncture effect. At the very minimum, the authors should have discussed these issues fully and critically.
- The acupuncturists of this study were also not blind. It is possible – I would argue, even likely – that they influenced patients to report or experience more positive results. Again, I would suggest that such effects suffice to generate a false-positive outcome.
- Even if there was a true effect of the verum beyond placebo, the question is, was it caused by acupuncture or the electrical current? There is a sizable body of evidence suggestion that electrotherapy might be effective for PHN!
In conclusion, the assertion that “electroacupuncture provided a statistically significant reduction in pain severity, increased responder rates, and improved pain-related functional outcomes” is uncritical, promotional and unjustified. I am once again dismayed that a reputable journal publishes such overt rubbish.
When a top journal like PNAS (Procedings of the Nationsl Academy of Science) publishes an article entitled “What’s the science behind acupuncture?“, I must take notice. Here is my take on the (sadly disappointing) effort:
My very short summary of the paper (I do encourange my readers to read it in full)
The article starts from the premise that acupuncture is proven to work, an assumption that – as we will see in a minute – is not based on sound evidence. It describes the evolution of acupuncture from a traditional practice rooted in ancient concepts like “qi” and “meridians” to a modern medical treatment increasingly validated by science. It argues that practitioners like Min Chen are today able to provide evidence-based explanations for their work. While early clinical trials were plagued by the “sham” acupuncture paradox, the text argues that more recent, rigorous studies and technological projects are bridging the gap between Eastern philosophy and evidence-based medicine, suggesting that acupuncture’s effects are physiological realities rather than mere placebo.
My concerns of the paper
The article attempts to bridge the gap between Traditional Chinese Medicine (TCM) and conventional medicine suggesting that several anatomical discoveries “correspond” to ancient meridians. This, however, is a post hoc ergo propter hoc fallacy. Finding a morphological structure (e.g. fascia) and claiming it represents the meridian system ignores that meridians were conceptualized as functional energetic conduits, not anatomical vessels. Citing an 80% overlap between acupoints and connective tissue planes lacks specificity. Given the ubiquity of connective tissue in the human frame, any randomized point on the body would likely “overlap” with a tissue plane, rendering the “meridian” map a possible exercise in pattern-seeking rather than anatomical discovery.
The paper acknowledges the “most puzzling” finding that sham acupuncture often produces results comparable to “true” acupuncture. This, it would seem to me, invalidates the foundational TCM theory of specific “acupoints” and “meridians” is invalidated. Yet, the article suggests that sham acupuncture is “not a true placebo” because it also triggers biological pathways. If needling anywhere produces an effect, acupuncture is merely a generalized, non-specific neuro-modulatory stimulus.
The article quotes Chen on “harmonizing organ functions” and “regulating qi” as well as researchers referring to “fibroblast activation” and “vagus nerve stimulation”. The author seems to consider both to be true; yet they seem mutually exclusive. Translating metaphysical concepts into physical phenomena does not “validate” the original theory but merely replaces it.
The article employs the opioid crisis to justify the rise of acupuncture. Yes, the need for non-pharmacological pain management is urgent, but clinical necessity does not equate to scientific validity. The text quotes the “lasting benefits” observed in some meta-analyses without discussing the often fatal flaws in these papers. Furthermore, it fails to cite the substantial body of evidence suggesting that acupuncture is not effective. Moreover, it hardly mentions the small effect sizes and hence limited clinical usefulness found in the positive studies.
The final section of the paper essentially rebrands acupuncture as “bioelectronic medicine”. If its mechanism of action is purely the electrical stimulation of the vagus nerve or the release of endogenous opioids, then the TCM concepts are all but superfluous. If a cheap and wearable TENS unit is more or less equivalent, the “meridian” and “qi” myths are obsolete.
In summary, the paper reads, I fear, only marginally better than a Chinese government promotional text – most disappointing for an article published in a journal of high standing. It attempts to preserve the cultural prestige of TCM while stripping it of its internal logic in order to make it compatible with science. For acupuncture to gain a true “scientific footing”, research must, in my view, move beyond finding “tantalizing” correlations. It should address fundamental problems, e.g.:
- As long as we have no convincing proof that acupuncture works beyond placebo, discussions about its mechanisms are futile.
- If qi, acupoints and meridians are illusions and irrelevant for the clinical outcome, then the science is not validating acupuncture but merely re-discovering a well-known non-specific form of peripheral nerve stimulation.
The ‘Smallwood Report‘, entitled “The Role of Complementary and Alternative Medicine in the NHS” was published in October 2005. It recommended greater integration of so-called alternative medicine (SCAM) into the UK’s National Health Service and to address “effectiveness gaps” in treating chronic and psychosocial conditions, claiming potential cost savings.
Its core recommendations were:
- NICE assessment: Urged Health Ministers to task the National Institute for Health and Clinical Excellence (NICE) with a full review of the cost-effectiveness of therapies like acupuncture, chiropractic, osteopathy, herbal medicine, and homeopathy.
- Targeted applications: Suggested these SCAM options for lower back pain (manipulative therapies over conventional), asthma (homeopathy), common colds (echinacea), and other chronic issues where orthodox medicine falls short, potentially reducing absenteeism and NHS costs by hundreds of millions.
- Implementation steps: Promote GP referrals to SCAM, target deprived communities, prioritize research on cost-effectiveness/safety, address regulatory barriers, and use case studies showing reduced GP visits and secondary care savings.
At the time, I called its evidence “grossly misleading,” citing ignored Cochrane reviews showing no superiority for most of the claims. Many critics agreed with me, and the Lancet editor Richard Horton famoulsy called it “dangerous nonsense”.
As the recommendations were pure BS, it is comforting to note that – 20 years later – they have been largely ignored.
NICE assessments:
NICE has issued selective endorsements—e.g., acupuncture and manipulative therapies for low back pain—but stopped short of broad SCAM evaluations, often citing “insufficient evidence” or requiring further trials, directly countering the report’s call for comprehensive cost-effectiveness reviews. No large-scale NICE program emerged to validate the report’s claimed savings (hundreds of millions annually), and guidelines frequently dismiss or deprioritize unproven modalities like homeopathy.
NHS integration status:
- Limited GP referrals: Sporadic pilots exist (e.g., acupuncture in some pain clinics, osteopathy/chiropractic for musculoskeletal issues), often GP-led and adjunctive, but not systematic; social prescribing now favors mindfulness over traditional SCAM.
- Funding barriers: Most Integrated Care Boards (ICBs) classify SCAM as “low priority” absent robust evidence, funding only exceptional cases in palliative or pain management pathways; many services closed due to austerity post-2010.
- No deprived-community focus: The report’s equity push for high-need areas saw negligible uptake, with barriers like clinician resistance and regulatory hurdles persisting.
The report’s optimistic case studies (e.g., Glastonbury) proved anecdotal and unscaled, undermined by critiques highlighting flawed evidence (e.g., ignored Cochrane reviews). Today, NHS policy emphasizes evidence-based conventional care, with SCAM relegated to private or niche settings – realization sits at ~10-20% for endorsed therapies, 0% for broader vision.
In other words, ignoring the report has saved the NHS many millions. More importantly, it has prevented UK evidence-based healthcare from getting watered down by ineffective therapies.
Could that also have happened without my loud protests (e.g. here and here) at the time?
Nobody can know for sure?
But when I feel a little bit down, I tell myself that I had an important role in saving the UK millions!
In recent decades, acupuncture has attracted extensive research spanning an astonishingly wide array of medical conditions, from chronic pain and neurological disorders to infectious diseases and psychiatric ailments. However, the proposed mechanisms of action—ranging from peripheral sensory stimulation to central nervous system modulation—fail to provide a coherent, biologically plausible explanation for efficacy across this disparate spectrum (Zhao et al., 2022; WHO, 2003).
The aim of this post is to examine the breadth of published acupuncture trials, delineate the leading scientific hypotheses for its mode of action, and outline the profound implausibility of these mechanisms universally applying to such varied pathologies, ultimately framing acupuncture as non-specific rather than a specific therapeutic modality (Meissner et al., 2019; Ernst, 2018).
Acupuncture has been subjected to thousands of randomized clinical trials (RCTs) and systematic reviews across virtually every medical specialty. A comprehensive 2022 evidence map published in BMJ Open synthesized 120 systematic reviews, encompassing 1,402 individual RCTs and addressing 77 distinct conditions within 12 broad therapeutic categories (Zhao et al., 2022). These categories include neurological disorders, musculoskeletal conditions, cardiovascular diseases, and beyond, reflecting a research enthusiasm that transcends conventional biomedical boundaries.
Neurological applications dominate, with trials targeting stroke sequelae such as hemiplegia and aphasia, vascular dementia symptoms, migraines, tension headaches, and facial nerve palsies like Bell’s palsy (Li et al., 2022; Zhao et al., 2022; WHO, 2003). Musculoskeletal trials are equally prolific, examining low back pain, knee osteoarthritis, fibromyalgia, tennis elbow (lateral epicondylitis), sciatica, shoulder periarthritis, rheumatoid arthritis, and even gouty arthritis (Li et al., 2022; Zhao et al., 2022; Choi et al., 2019; Lam et al., 2020; WHO, 2003). Cardiovascular research has probed essential hypertension, primary hypotension, and pain from thromboangiitis obliterans (Shanghai Medical Clinic, 2025; WHO, 2003). Gynecological and obstetric domains feature prominently, including dysmenorrhea, labor induction, breech presentation correction, pregnancy-related nausea and vomiting, and fertility enhancement (e.g., improved clinical pregnancy rates in IVF protocols) (Zhao et al., 2022; Shanghai Medical Clinic, 2025; Smith et al., 2021; Carr, 2022; WHO, 2003).
Acupuncture trials also extend to psychiatric conditions like generalized anxiety disorder (especially in perimenopause), depression, and other mental disturbances (Zhao et al., 2022; Zhang et al., 2025; WHO, 2003); respiratory issues such as allergic rhinitis and hay fever (Li et al., 2022; Shanghai Medical Clinic, 2025; WHO, 2003); gastrointestinal disorders including acute and chronic gastritis, biliary colic, and postoperative nausea/vomiting (Zhao et al., 2022; Shanghai Medical Clinic, 2025; WHO, 2003); urogenital and nephrological problems like renal colic and radiation-induced leucopenia (often in renal contexts) (Shanghai Medical Clinic, 2025; WHO, 2003); infectious diseases such as acute bacillary dysentery, pertussis (whooping cough), and epidemic hemorrhagic fever (WHO, 2003); pediatric applications, albeit more limited, for post-extubation pain relief and whooping cough (ClinicalTrials.gov, 2013; WHO, 2003); and oncology support for cancer-related fatigue and chemotherapy/radiation side effects (Zhao et al., 2022; Shanghai Medical Clinic, 2025). Additional niches include ear-nose-throat conditions (e.g., rhinitis), eye disorders, connective tissue diseases, metabolic/nutritional imbalances, and skin pathologies (Zhao et al., 2022; WHO, 2003).
This extraordinarily wide spectrum, drawn from seminal analyses like the World Health Organization’s (WHO) 2003 review of controlled clinical trials (WHO, 2003) and Cochrane overviews on pain (Choi et al., 2019; Lee et al., 2011), clearly demonstrates that acupuncture is considered by its proponents to be a ‘cure all’. This begs the question whether such an assumption can be reasonable. The effect sizes are typically modest, and true acupuncture is often no different from sham interventions (e.g., superficial needling at non-acupoints), suggesting limited specific efficacy (Lee et al., 2011).
The scientific literature proposes a constellation of mechanisms to explain how acupuncture might work, integrating peripheral, spinal, supraspinal, and systemic processes. These are often conceptualized through the “Neural Acupuncture Unit” (NAU) model, which posits low-threshold mechanosensitive afferents (Aδ and C fibers) at acupoints converging with brain networks to elicit bidirectional signaling (Zhang et al., 2012).
- Peripheral and Local Mechanisms. Needle manipulation is claimed to induce immediate tissue responses: adenosine triphosphate (ATP) breakdown to adenosine activates A1 receptors, dampening nociceptor firing (Kelly & Suckley, 2016); axonal reflexes release neuropeptides like substance P and calcitonin gene-related peptide (CGRP), modulating local inflammation; and stromal cells exhibit cytoskeleton remodeling, with collagen fibers “wrapping” around needles to propagate mechanical signals (Kelly & Suckley, 2016; Zhang et al., 2012; Li et al., 2025). The characteristic deqi sensation (aching, soreness) correlates with these events, potentially amplifying sensory input (Staud & Price, 2014).
- Spinal Cord Level. Ascending afferents are said to activate the gate control system, presynaptic inhibition, and diffuse noxious inhibitory controls (DNIC), releasing endogenous opioids (β-endorphin, enkephalins, dynorphins), serotonin, norepinephrine, and acetylcholine to suppress nociceptive transmission in the dorsal horn (Kelly & Suckley, 2016; Zhang et al., 2012; Staud & Price, 2014). This underpins analgesia and autonomic regulation, such as reduced sympathetic outflow (Kelly & Suckley, 2016).
- Central Nervous System Modulation. Functional neuroimaging (fMRI, PET) reveals deactivated limbic hyperactivity (amygdala, anterior cingulate), normalized hypothalamic-pituitary-adrenal (HPA) axis activity, and enhanced prefrontal connectivity, particularly in pain, stress, and mood disorders (Kelly & Suckley, 2016; Zhang et al., 2012; Wang et al., 2025). Top-down expectancy modulates descending inhibitory pathways, integrating with reward and mirror neuron systems (Zhang et al., 2012).
- Systemic and Humoral Effects. Acupuncture is also thought to influence immune homeostasis by shifting cytokine profiles (e.g., ↑IL-10, ↓TNF-α, ↓IL-6), autonomic balance (vagal enhancement), and endocrine axes, providing a basis for visceral, metabolic, and inflammatory conditions (Kelly & Suckley, 2016; Li et al., 2025). Recent integrative studies emphasize network pharmacology, where multi-point stimulation perturbs interconnected pathways (Li et al., 2025).
These potential mechanisms have been empirically observed in animal models and/or human imaging studies. They might offer a partial rationale, primarily for analgesia and stress-related syndromes (Kelly & Suckley, 2016; Zhang et al., 2012). The question, however, is whethr they can provide a full explanation for acupuncture’s efficacy in all the above-named conditions.
No synthesis of these mechanisms plausibly accounts for acupuncture’s claimed benefits across unrelated conditions, exposing a core scientific paradox. Musculoskeletal pain might align with local adenosine/opioid effects and spinal gating (Kelly & Suckley, 2016), but how do these explain microbial clearance in bacillary dysentery, hypertensive vascular remodeling, or synaptic imbalances in major depression? (Meissner et al., 2019; Ernst, 2018). Gynecological infertility involves ovarian endocrinology, distant from needle-evoked sensory cues; infectious pertussis implicates Bordetella immunity, not HPA modulation (WHO, 2003; Meissner et al., 2019). This biological implausibility echoes homeopathy critiques: a single intervention cannot verifiably target such heterogeneous pathophysiologies without invoking non-specific forces (Fabrizio et al., 2010).
Trial data reinforce these doubts: meta-analyses consistently show that verum acupuncture is hardly different from sham acupuncture, and sham elicit up to 80% of verum’s effects (Kelly & Suckley, 2016; Meissner et al., 2019; Fabrizio et al., 2010; Kaptchuk et al., 2013). Such considerations implicate patient and therapist expectations, therapeutic ritual, and patient-practitioner alliance as the true mechanism behing the observed outcomes (Meissner et al., 2019; Kaptchuk et al., 2013). Neuroimaging effects often mirror expectancy manipulations in non-needling studies, suggesting top-down confounds (Fabrizio et al., 2010). Lab phenomena (e.g., adenosine release) occur but yield trivial clinical effects, dwarfed by psychosocial amplification (Fabrizio et al., 2010).
Acupuncture’s elaborate ritual maximizes contextual healing, outperforming inert pills but lacking disease-modifying specificity (Meissner et al., 2019; Ernst, 2018). Paradoxes abound—positive preclinical signals evaporate in blinded RCTs; cultural bias inflates Asian trial positives; poor sham penetration and blinding failures perpetuate illusions (Fabrizio et al., 2010; Ernst, 2018). For non-pain conditions, evidence thins further, with publication bias and flexible outcome reporting inflating apparent successes (Fabrizio et al., 2010).
Acupuncture carries risks including minor issues like bleeding, needle site pain, vegetative reactions (e.g., dizziness or nausea), and symptom aggravation, alongside rarer serious events such as pneumothorax, infections, or organ injury. Overall, at least one adverse event in 9.31% of patients undergoing a treatment series or 7.57% of treatments, with half of these being mild local reactions. Serious adverse events seem to be uncommon. Reliable prevalence figures do not exist because there is no adequate surveillance system in place (Ernst 2006).
Acupuncture’s trial proliferation signals cultural and patient-driven demand rather than mechanistic or evidential triumph. Its broad therapeutic claims by far overreach evidence (Staud & Price, 2014). Rigorous advancement would require objective biomarkers (e.g., cytokine assays, EEG), dose-response optimization, adaptive sham designs, and large pragmatic trials stratifying contextual from specific effects (Zhang et al., 2012; Fabrizio et al., 2010). Until compelling evidence exists, acupuncture remains a testament to human suggestibility’s power, but not a biomedical panacea.
References
- Carr, D. (2022). Acupuncture as Treatment for Female Infertility. Medical Acupuncture, 34(1), 12-21.
- Choi, D., et al. (2019). Cochrane reviews on acupuncture therapy for pain: a snapshot of the current evidence. Systematic Reviews, 8, 231.
- ClinicalTrials.gov. (2013). Pediatric Laser Acupuncture and Renal Biopsy (NCT01879826).
- Ernst, E. (2006). Acupuncture–a critical analysis. J Intern Med, 259(2):125-37.
- Ernst, E. (2018). Acupuncture Research: The Problem. Pain Medicine, 19(6), 1287-1288.
- Fabrizio, P., et al. (2010). Paradoxes in Acupuncture Research: Strategies for Moving Forward. Explore (NY), 6(4), 231-239.
- Kaptchuk, T. J., et al. (2013). Are All Placebo Effects Equal? Placebo Pills, Sham Acupuncture, or Placebo Needle in Irritable Bowel Syndrome. PLoS ONE, 8(7), e67485.
- Kelly, R., & Suckley, S. (2016). Mechanisms of acupuncture. European Journal of Integrative Medicine, 20, 1-11.
- Lam, M., et al. (2020). Acupuncture and Chronic Musculoskeletal Pain. Medical Acupuncture, 32(6), 357-366.
- Lee, M. S., et al. (2011). Acupuncture for pain: an overview of Cochrane reviews. Chinese Journal of Integrative Medicine, 17(3), 187-189.
- Li, T., et al. (2022). Evidence on acupuncture therapies is underused in clinical practice. Frontiers in Medicine.
- Li, Y., et al. (2025). Integrative research on the mechanisms of acupuncture. Neural Regeneration Research.
- Meissner, K., et al. (2019). Acupuncture for the Treatment of Pain – A Mega-Placebo? Frontiers in Neuroscience, 13, 1119.
- Shanghai Medical Clinic. (2025). WHO Approved Acupuncture List of Conditions.
- Smith, C. A., et al. (2021). An Overview of Systematic Reviews of Acupuncture for Respiratory Diseases. Frontiers in Public Health.
- Staud, R., & Price, D. D. (2014). Acupuncture therapy: mechanism of action, efficacy, and safety. International Review of Neurobiology, 111, 171-189.
- Wang, L., et al. (2025). Possible antidepressant mechanism of acupuncture. Frontiers in Neuroscience, 19, 1512073.
- WHO. (2003). Acupuncture: Review and Analysis of Reports on Controlled Clinical Trials.
- Zhang, R., et al. (2012). Neural Acupuncture Unit: A New Concept for Interpreting Effects and Mechanisms of Acupuncture. Evidence-Based Complementary and Alternative Medicine, 2012, 429412.
- Zhang, Y., et al. (2025). Patient-reported outcome tools of acupuncture clinical trials. Journal of Pain Research.
- Zhao, C., et al. (2022). Evidence mapping and overview of systematic reviews of the effects of acupuncture therapies. BMJ Open, 12(6), e056803.
This study aims to integrate the Geomagnetic Field (GMFD), Quantum Field (QFD), and Human Biofield (HBFD) domains as biophysical foundations for an energetic continuum between cosmic forces and human physiology, grounded in Traditional Chinese Medicine (TCM) concepts like Qi and Yin-Yang.
A structured narrative review was conducted. A systematic search of major scientific databases (PubMed, Scopus, Web of Science, and Google Scholar) was performed, employing tailored Boolean queries to combine core keywords and domain specific terminology. Identified studies were systematically screened and categorized by domain (GMFD, QFD, HBFD) and research design, followed by a thematic synthesis to identify convergent mechanisms and biophysical linkages.
Evidence indicates GMFD activity modulates neurophysiological and immune processes, including alpha band desynchronization (p < 0.05), autonomic regulation under ultra-low frequency oscillations (r = 0.46, p < 0.01), and reduced leukocyte counts during disturbances (−17.5 cells/mm³, p < 0.001). Fetal head circumference was affected biphasically (β = 0.04 pre-24 weeks; β = −0.25 post-24 weeks, p < 0.05). However, there is an urgent need for more research with reproducible and reliable methods to consolidate these findings. Quantum processes (biophotons, tunneling) and Biofield Therapies provided complementary mechanisms consistent with Qi’s attributes. The Integration Diagram of Energy Domains (IDED) was formulated based on these syntheses.
The authors concluded that the integration of GMFD, QFD, and HBFD offers an innovative biophysical model aligning with TCM principles, supporting its scientific legitimacy and promoting its inclusion in integrative health frameworks.
Where to begin?
The paper proposes a speculative biophysical model linking geomagnetic fields, quantum fields, and human biofields to Traditional Chinese Medicine (TCM) concepts like Qi, but it lacks rigorous scientific validation. The study is framed as a “structured narrative review” with a systematic search, yet it relies on selective thematic synthesis rather than quantitative meta-analysis or risk-of-bias assessment. Reported effects, such as geomagnetic influences on alpha waves (p < 0.05) or leukocytes (−17.5 cells/mm³, p < 0.001), stem from heterogeneous, low-quality studies often plagued by small samples, confounding variables (e.g., stress during geomagnetic storms), and non-reproducible methods—the paper itself urges “more research with reproducible methods.” No PRISMA guidelines are followed, enabling cherry-picking of supportive findings while ignoring contradictory evidence, like null effects in controlled magnetoreception trials.
Geomagnetic field (GMFD) effects on physiology are overstated; while weak links exist to circadian rhythms via cryptochromes in animals, human data show inconsistent, correlational impacts (e.g., r = 0.46 for autonomic changes) without causation or mechanistic clarity. Quantum field (QFD) invocations (biophotons, tunneling) misapply fringe quantum biology concepts—biophotons are ultra-weak emissions with no proven regulatory role, and biological quantum effects (e.g., in photosynthesis) do not scale to macroscopic “Qi” phenomena. Human biofield (HBFD) remains pseudoscientific; therapies like Reiki show placebo-level outcomes in rigorous trials, with no detectable energy fields via standard physics instruments.
Equating TCM’s pre-scientific Qi/Yin-Yang to modern biophysics is pure pseudoscience, projecting metaphysical ideas onto preliminary data without falsifiability. The “Integration Diagram of Energy Domains (IDED)” is an untested schematic, not empirical evidence, echoing historical attempts to scientize homeopathy or chakras that failed under scrutiny. True integration demands randomized controlled trials of TCM interventions outperforming placebos, which they consistently do not for most indications.
This model promotes TCM’s “scientific legitimacy” prematurely, risking integration into health frameworks without efficacy proof. It exemplifies “quantum woo”—vague physics jargon to lend credibility to unverified claims—while biofield research faces preclinical challenges like poor reproducibility and placebo confounds.
Or, to put it bluntly:
THIS IS BULLSHIT!
We have frequently discussed the fact that acupuncture, while often promoted as safe, can cause serious harm, including deaths, e.g.:
- Another death by acupuncture
- Death by acupuncture
- Football star, Ellen White, suffered a pneumothorax caused by acupuncture
- Acupuncture: much more than meets the eye!
- Acupuncture for stable angina pectoris… yes, if you aim at killing millions!
- Acupuncture: a treatment to die for?
- How many fatalities has acupuncture caused? And are acupuncturists in denial?
Now, an unusual fatality has been reported. A team of Chinese researchers published the case of a young man who died suddenly after receiving acupuncture treatment. Autopsy revealed multiple needlestick wounds in both lungs, liver, and spleen, leading to traumatic pneumothorax and hemoperitoneum. The man ultimately died of respiratory failure.
Notably, the case documentation mentioned only dorsal acupuncture. However, during the autopsy, the authors discovered additional puncture sites in the bilateral lateral regions, with dimensional discrepancies compared to the dorsal needlestick. They hypothesized that these discrepancies were caused by the use of needles of varying sizes and raised reasonable suspicion of multiple perpetrators. A subsequent law enforcement investigation confirmed that the man’s dorsal and lateral acupuncture were performed separately by a masseur at a private clinic and by his partner. A detailed analysis clarified how injuries to different anatomical regions contributed to the fatal outcome, providing a foundation for legal accountability.
The uniqueness of this case lies in the involvement of multiple suspects, multiple organ injuries, and unlicensed medical practice. This case not only enriches the report on adverse events associated with acupuncture but also highlights the critical importance of meticulous forensic examination and comprehensive case investigation.
The authors stress that improper practices may lead to adverse events. This case involves issues of unlicensed medical practice leading to death, multiple organ injuries, multiple suspects (including one who is the decedent’s partner), and the division of responsibility. It highlights that even minor puncture injuries can result in serious damage, serving as a warning that meticulous and comprehensive forensic examinations, along with the independent analytical skills, are crucial for uncovering key information that may be easily overlooked. These abilities enable timely provision of clues to the police, bringing the case closer to the truth.
I would add that the paper clearly demonstrates that not only acupuncture but also the acupuncturist can cause severe harm, particularly when he/she is poorly or not at all trained.
The objective of this study was to “critically assess the evidence presented in randomized controlled trials (RCTs) about the effectiveness of acupuncture on fatigue in cancer patients”. In April 2024 a systematic search was conducted searching five electronic databases to find studies concerning the use, effectiveness and potential harm of acupuncture therapy on cancer patients.
From all (1599) search results, 15 studies with 1346 patients were included. Acupuncture methods varied – e.g., traditional-, electro-, mind-regulating and ATAS-acupuncture – and were compared to sham acupuncture, usual care, or other controls.
- Studies comparing acupuncture to sham acupuncture reported mixed results: while some found significant effects on cancer-related fatigue, others found no advantages.
- Studies comparing acupuncture to usual care or waitlist controls often reported positive effects. However, the reliability of these findings is limited, as 14 of 15 studies were rated as “high risk of bias” by the RoB-2 tool due to issues like insufficient blinding and incomplete data analysis.
- Only one study, with low risk of bias, showed a significant reduction in fatigue with acupuncture compared to sham acupuncture (p < 0.001).
- GRADE evaluation showed very low certainty of evidence.
The authors concluded that the heterogenous results and methodological limitations of the existing studies prevent us from drawing definitive conclusions about the effectiveness of acupuncture in the treatment of cancer-related fatigue. Despite the inclusion of 15 studies, the overall evidence remains insufficient due to widespread problems in study design and inconsistent results. This analysis highlights the need to use more rigorous designs and more comprehensive assessment tools in future studies to better understand the role of acupuncture in the management of fatigue after cancer treatment.
So, only one study, with low risk of bias, showed a significant reduction in fatigue with acupuncture compared to sham acupuncture. Let’s have a look at it:
Background: Cancer-related fatigue (CRF) is a distressing symptom that is the most common unpleasant side effect experienced by lung cancer patients and is challenging for clinical care workers to manage.
Methods: We performed a randomized, double-blind, placebo-controlled pilot trial to evaluate the clinical effect of acupuncture on CRF in lung cancer patients. Twenty-eight patients presenting with CRF were randomly assigned to active acupuncture or placebo acupuncture groups to receive acupoint stimulation (LI-4, Ren-6, St-36, KI-3, and Sp-6) twice per week for 4 weeks, followed by 2 weeks of follow-up. The primary outcome was the change in intensity of CFR based on the Chinese version of the Brief Fatigue Inventory (BFI-C). As the secondary endpoint, the Functional Assessment of Cancer Therapy-Lung Cancer Subscale (FACT-LCS) was adopted to assess the influence of acupuncture on patients’ quality of life (QOL). Adverse events and safety of treatments were monitored throughout the trial.
Results: Our pilot study demonstrated feasibility among patients with appropriate inclusion criteria and good compliance with acupuncture treatment. A significant reduction in the BFI-C score was observed at 2 weeks in the 14 participants who received active acupuncture compared with those receiving the placebo (P < 0.01). At week 6, symptoms further improved according to the BFI-C (P < 0.001) and the FACT-LCS (P = 0.002). There were no significant differences in the incidence of adverse events in either group (P > 0.05).
Conclusion: Fatigue is a common symptom experienced by lung cancer patients. Acupuncture may be a safe and feasible optional method for adjunctive treatment in cancer palliative care, and appropriately powered trials are warranted to evaluate the effects of acupuncture.
Fancy that! The only study to produce some apparently sound evidence turns out to be a pilot study. Such studies are supposed to test feasibility, not effectiveness! In view of all this, it is far, I think, to draw a definitive conclusion, after all:
At present there is no compelling evidence that acupuncture works for cancer-related fatigue.
Yesterday, I posted the account of a WHO summit on so-called alternative medicine (SCAM). I deliberately abstained from any comment. Yet, the arguments put forward do certainly deserve some critical evaluation. In particular, I feel that this paragraph needs discussing:
The WHO says its Summit on Traditional Medicine is essentially about repeating this sifting process for traditional remedies used in other parts of the world. It aims to apply rigorous scientific analysis to all them in order to properly assess their claimed benefits and potential harms. By 2034, it says, it will publish a definitive list of which traditional treatments work – and which don’t. “Working on traditional medicine doesn’t mean we will use shortcuts or endorse things that are unproven,” Dr Sylvie Briand, the WHO’s Chief Scientist, told The Telegraph at the conference in New Delhi. The aim was first to document what traditional treatments existed around the world “and then see what could be more useful to address the disease of this century”.
To many readers such words (which are voiced regularly) might seem entirely reasonable. Yet, they clearly are not! So, let me pick them apart.
Applying rigorous scientific analysis to all SCAMs in order to properly assess their claimed benefits and potential harms. This plan looks fine – but only if you know little bit about the subject:
- It is obvious that not every nonsensical idea merits proper assessment. Many can be rejected out of hand by simply using common sense. A Peruvian man’s piercing ululation, for instance, might not require scientific testing – or, to put it bluntly, testing nonsense will result in nonsense and is a waste of money.
- It is a demonstrable fact that many other SCAMs have already been assessed properly and most have been found wanting. In my recent book, for example, I have evaluated 202 SCAMs and found only a handfull that pass muster. The problem for the WHO and other such organisations or individuals is not that the evidence is unavailable, but that they elect to ignore it.
- And that leads to a further important point. What the WHO and other organisations or individuals call “to properly assess” might not coincide with what scientists would consider a critical evaluation of the best available evidence. As we have seen with depressing regularity on this blog, biased assessments inevitably result in false-positive conclusions.
By 2034, the WHO will publish a definitive list of which traditional treatments work and which don’t. This might look encouragingly ambitious but it is not. On the conreary, it is discouragingly naive and totally impossible. Let me use just one of the many hundred SCAM modalities, acupuncture, to explain this in more detail:
- There are dozens of different types of acupuncture, e.g. traditional, Western, Korean, Japanese, needle, ear, body, scalp, tongue, electro, etc., etc.
- Acupuncture is touted as a panacea; this means each form of acupuncture would need to be tested in clinical trials of thousands of different conditions.
- Moreover, there are uncounted different treatment schedules with acupuncture.
- Even if rigorous, one trial can never enough for a firm verdict. To make sure that the result of one single trial is not a fluke, we need several independent replications.
- Combining all these imponerabilities would require thousands clinical trials and many decades before one could claim that one has established that this form of acupuncture works for this condition, and that form of acupuncture does not.
- In case the eventual verdict for acupuncture for any given condition is negative, some clever dick would surely emerge and claim, “but, of course, you did not do the test correctly! So, your verdict is mistaken”
- Add to this the fact that hundreds of different SCAM modalities exist and most of them claim to be a cure-all, we would not need a decade but several centuries to arrive at the embarrassingly naive aim of the WHO.
Considering these problems, I fear, that the ‘WHO Summit on Traditional Medicine’ might be full of good will [to be entirely honest, I am not even sure that this is true!] but this and similarly ignorant, naive and promotional initiatives certainly are leading us up an expensive, wasteful and dangerous garden path.
PS
Oh, I almost forgot!
To criticize is easy, some will say.
Why does Ernst not show us how it should be done properly?
How do we arrive at a point where we can say: THIS SCAM WORKS FOR THIS CONDITION, AND THAT SCAM DOES NOT?
The proper way of achieving this goal is to do what we do in all medicine and remember that the onus of proof lies on the shoulders of those who make the therapeutic claim. In other words, if acupuncturists claim that a certian type of acupuncture can effectively treat asthma, for example, let them come up with the evidence! Until the evidence is on the table, the claim should be viewed as unproven which means the treatment cannot be recommended.
Simple!
