Acupuncture has no real benefit

Apparently fake acupuncture is as effective as real acupuncture. Unfortunately Michael Kahn of news24 completely missed the boat when he reported on the work of Klaus Linde and the Cochrane Collaboration. Kahn represents Linde’s work at the Technical University in Munich as positive for acupuncture when his article claims that acupuncture treatment works “just as well” when the needles are correctly inserted into the hypothetical meridians of ch’i as it does when they are not. 

Perhaps Kahn is unaware of what acupuncture actually is, and perhaps he is also woefully ignorant of how scientific trials work. Let me try to clear up some of the confusion, I will start with the acupuncture.

Acupuncture is an ancient medicinal treatment based on the idea that a persons health and well being depend on the uninterrupted flow of an innate life force, a special kind of energy widely known as ch’i, through pathways (known as meridians) in the human body. Acupuncturists pierce the skin with fine needles at important points along the meridians in order to remove blockages and encourage the correct flow of ch’i.

In his excellent book, Bad Science*, Ben Goldacre highlights six central principles of acupuncture. There are many schools of acupuncture and they have evolved slightly different interpretations of ch’i, however they all maintain the following core tenets;

  • Each meridian is associated with and connects to one of the major organs of the human body.
  • Each meridian has an internal and external pathway.
  • There are hundreds of possible acupuncture points along the meridians
  • Depending on the school and condition being treated, the acupuncturist will insert needles at particular points on particular meridians.
  • The penetration depth varies from 1cm to 10cm and often the therapy involves rotating the needles in situ.
  • Needles can be left in place for a few seconds or a few hours.

From the above principles it is abundantly clear that the concept of ch’i and it’s pathways throughout the body are absolutely critical to the practice of acupuncture. If your needles are not being placed in the meridians you cannot be influencing the ch’i and you are not performing acupuncture.

Unfortunately for proponents of acupuncture, there is no evidence for the existence of this life energy whatsoever. The very concept of ancient life force was developed in pre-scientific times. People did not understand the way the body works and they came up with the best story which they could to describe what they observed.

Chinese medicine grew up in a society which did not allow human dissection, as such the Chinese medicinal system was based on the world around them. The human body was interpreted as a microcosm of the universe as opposed to understanding it in terms of it’s own reality. Having been based on hand waving and story telling, acupuncture is at a very real disadvantage.

In Europe a very different understanding of the human body was developed, one which depends on facts and evidence. A definitive way of winnowing the facts from the tripe is by the use of the randomised controlled trial. The Bandolier journal has published an excellent meta-analysis of clinical trials of acupuncture which helps us to understand how feeble acupuncture is. When Kahn tells us that “Acupuncture prevents headaches and migraines” he is actually asking us to believe something for which there is no convincing evidence at all.

The claim that ‘fake’ acupuncture has equal benefit to the ‘real’ thing is utter nonsense. Michael Kahn clearly does not understand the concept of placebo and is too lazy to do a little research. The concept of placebo is a little complex, wikipedia defines the placebo effect as follows;

The placebo effect is a medical phenomenon in which a physiologically inert treatment, or placebo, improves a patient’s condition relative to similar patients who receive no treatment at all. One well-known placebo effect occurs when a patient is treated with an inert pill or a sham surgery. Although these placebos cause no medically relevant changes to the body, patients who are treated with them will improve more on average than patients who receive no treatment. The placebo effect can also be an additional boost for a real therapy or drug beyond that warranted solely by its actual physiological action.

Despite many rigorous trials and years of testing, acupuncture has not been proven to have an effect better than placebo for the ailments it is supposed to be good for. Furthermore, there are numerous complaints which are treated with acupuncture where the treatment has no effect at all. If sham acupuncture is as effective as the real thing, then real acupuncture has no benefit. It is as simple as that.

In his blog, Bad Science, Dr Ben Goldacre discusses this exact topic (and he does it far better than I do). Whilst Dr Goldacre’s article takes a close look at the mechanisms of back pain and how simply being in a trial can influence a persons health, I would like you to learn something a little different from mine.

Acupuncture is magical thinking woo-woo science. There is no evidence for it’s efficacy. Fake acupuncture, real acupuncture, placebo, what’s the difference? There is no difference. Because neither acupuncture nor sham stick-a-needle-anywhere acupuncture has any measurable benefit.

*edit – I previously mis attributed Simon Singh and Edzard Ernst’s book “Trick or Treatment” to Dr Goldacre. My humble apologies.

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13 responses to “Acupuncture has no real benefit

  1. “some egotist doctors disagree with this for sure” – This is a terrible argument. Science does not disagree with anything. If acupuncture can be shown to be effective it will be readily accepted by the medical community.
    Now science may not ‘disagree’ with anything but people are responsible for the creation and application of the explanatory structure that is science and they agree and disagree for all sorts of different reasons not all of them rooted in cold hard logic and based on empirical data.
    “alternative medicine because it is inexpensive” – Anything which costs money but offers results no better than placebo is expensive.
    Well actually if you’re broke and a placebo is good enough to make your condition improve which it frequently is, then I’d probably call that money well spent, no?
    “personal interviews with patients who had undergone acupunture and they were healed” – Anecdotal evidence is not evidence.
    And ‘healed’ is a very subjective term with a very wide variety of possible definitions that might mean a great deal about someone’s inner perspective, spiritual values and explanatory structures for their life. In that context anecdotal is as good as we are going to get.
    “Doctors are just scared that all patients would consider an acupunturist rather than expensive surgery” – another unfounded assertion. If acupuncture worked, doctors would use it.
    This works again on the assumption that the only guiding hand in the life of an individual or collective group is cold hard logic. Cursory contact with any such large body of logic oriented individuals will reveal that this isn’t so. Other factors play a part all the time because they are also people doing the things that people do. So this may well not be true.
    “some of my cysts are gone and feeling good” – reversion to the mean. placebo effect.
    It was cheap, patient is feeling better.

  2. I have heard about acupucture since I was a kid and I always believed that the chinese were ahead in inventing wonder drugs, some egotist doctors disagree with this for sure… i have known a lot of sick relatives had turned into alternative medicine because it is inexpensive.. I’m a journalist myself and have conducted personal interviews with patients who had undergone acupunture and they were healed… you guys need to research more and talk to people who benefitted from acunpunture.. Doctors are just scared that all patients would consider an acupunturist rather than expensive surgery… Just a few weeks i started my acupunture and some of my cysts are gone and feeling good after treatment and yet it is bloodless.

    • Have you read “Trick or Treatment” by Ben Goldacre? If you are interested in alternative medicine, it is an invaluable source of information.

      “some egotist doctors disagree with this for sure” – This is a terrible argument. Science does not disagree with anything. If acupuncture can be shown to be effective it will be readily accepted by the medical community.

      “alternative medicine because it is inexpensive” – Anything which costs money but offers results no better than placebo is expensive.

      “personal interviews with patients who had undergone acupunture and they were healed” – Anecdotal evidence is not evidence.

      “Doctors are just scared that all patients would consider an acupunturist rather than expensive surgery” – another unfounded assertion. If acupuncture worked, doctors would use it.

      “some of my cysts are gone and feeling good” – reversion to the mean. placebo effect.

  3. “So far the weight of evidence says yes. Acupuncture has no tangible benefit.”

    Sounds like you’re jumping the gun. How is this “weight of evidence” evaluated objectively, reproducibly and quantifiably? Did you perform a meta-analysis of meta-analyses, or something on that order? I doubt it. I think “weight of evidence” just a fancy way for you to say “I have a hunch”.

    Based on Goldacre’s Lancet article and other meta-analyses, I’d buy the “weight of evidence” argument for homeopathy. But it’s demonstrably not the case for acupuncture. If it were, then there would be excellent inter-reviewer reliability, i.e. other reviewers would agree with you that the evidence suggests no tangible benefit to acu. But that’s not the case, as anyone browsing Pubmed a/o Cochrane can see.

    http://www.ncbi.nlm.nih.gov/pubmed/17224820
    http://www.ncbi.nlm.nih.gov/pubmed/15674876
    http://www.ncbi.nlm.nih.gov/pubmed/15266478

    It would be reasonable to take the position that the evidence is equivocal, and your opinion is that over time we’ll find it’s negative. It would also be reasonable to opine that needling certain points probably will be found to be effective once the controls are all worked out. But meta-analyses don’t support either conclusion yet. For a number of conditions, the Cochrane reviews conclude with a statement to the effect that there’s not enough evidence to say whether or not acu is beneficial for X condition. That’s how scientists tend to be: conservative in their conclusions.

    And that’s why peer-review is a whole lot different than throwing together a blog post, repeating some polemic gleaned from the usual Skeptical types, and then saying that your hunch is based on something called “the weight of evidence”.

  4. I read Ben’s book and I agree it’s excellent. I think he said that there was a very small benefit of acupuncture over placebo, which is quite interesting in itself if it is significant (I got “Bad Science” from the library so I can’t check).

    He also talks in great depth about the placebo effect. One interesting aspect of this is that saline injections work better than tablets – the idea being that the more invasive stuff gives a bigger effect.

    Your stipulation that “neither acupuncture nor sham stick-a-needle-anywhere acupuncture has any measurable benefit.” is not strictly true, as both have a measurable benefit over doing nothing. When done properly (by which I mean not necessarially hitting the right points, but not causing HIV from contaminated needles and not perforating the pleural cavity as has I believe happened on occasion) they provide a useful placebo effect with relatively few side effects, which is one reason why some people repeatly use them.

    A more controversial aspect of acupuncture is their use in animals, where the placebo effect, while present, is harder to measure and contaminated by what I’ll call “indirect placebo” – a pet owner’s belief that because a pet has had acupuncture it will do better, meaning that they notice good signs more than bad ones. Because of this I don’t recommend acupuncture to my veterinary clients, but try not to diss it in the human field (on the basis that if people believe the effect is all placebo that will presumably diminish the benefits).

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  7. So far the weight of evidence says yes. Acupuncture has no tangible benefit. Many people argue that the placebo effect, whereby our bodies respond to a treatment even though there is no medical effect, can be considered beneficial. However I tend to feel that a medical treatment based on science and proven to help because it has a measurable mechanism is far more reliable.

  8. JT please provide a reference to substantiate your claim that acupuncture provides quantifiable benefit?

    Your argument that thousands of US citizens seek acupuncture treatment is a logical fallacy known as the argument ad populi (lit. the argument from popularity),the fact that an alternative medicine is popular does not mean that it is effective.

    Furthermore, I do the best research I can on any topic I write about. I then write an opinion piece about the topic. I am always willing to evaluate evidence on a given topic and aways prepared to adjust my opinion based on the weight of evidence.

  9. Your contention that there is no measurable benefit is ignorant of the current research of medical science as well as the abundance of empirical data showing quantifiable improvement in motor function, sleep, fertility, and sexual function. Acupuncture is being used by thousands around the U.S. to solve problems that other more familiar therapies have not.
    Dismissing it as placebo effect is not even worth addressing.
    Your post on acupuncture is one of the reasons blogs are kind of a woo-woo journalism, where you have failed to do any reporting or research, much less a simple homework assignment on the topic.

  10. Thanks Spear
    If you read through my blog a little you will see that I have addressed homeopathic “remedies” on more than a few occasions.

    SD

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