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Hitting the Needle on the Head

Acupuncture is one of those medical treatments that a lot of people swear by. I find that most of the trust in the treatment comes along with the allure of an ancient ritual, thousands of years “verified”. But has it been verified? Based upon the evidence which I will show later on, acupuncture can not even beat placebo.

As with homeopathy, you might say, what is the harm in using this treatment? If it works for you isn’t that OK? I have a problem with acupuncture because it perpetuates many critical thinking follies that skeptics laboriously try to discredit. Not only that, but it lures away potential doctors (the real ones) to a field that takes an additional 3-4 years from them that they could use actually contributing to the medical community, rather than relying on ancient, unproven, placebo driven, “medicine”. I assume that you can sense my harsh tone in regards to this topic. I will admit, this makes me a little angry, but I have good reason. I firmly believe that if someone (my mother for example) had more information, that is to say, good science information on this topic, she could have saved the thousands of dollars she dumped into a “licensed” acupuncturist (they necessitate a salary of sometimes 200,000-300,000 dollars a year).

I will restate my qualms:

  • Acupuncture does not work beyond placebo (I will show this below)
  • Years of training are wasted, while I could achieve similar results with no training whatsoever (shown below).
  • Acupuncture treatment demands copious amounts of money (this treatment should not warrant payment beyond that of perhaps a massage)
  • Acupuncture stands in the face of good science with unsubstantiated claims, and you should care about that (I think).

Let’s take a look at the evidence…

If Fake Acupuncture Works, Acupuncture Does Not Work!

Many studies have shown that when merely using the ritual of acupuncture (insertion or pressure of needles), with no regards to any of the suggested “pressure points, meridians” etc., works in a statistically significant way to remove certain types of pain. However, when new organizations have reported this, they make the conclusion that acupuncture still works. Does this make any sense? Take this example:

A study of Tylenol finds that among their test groups, the groups that received Tylenol, and the sugar pill that just looked like Tylenol, fared equally, but much better in relieving pain than the group who took nothing. The study then concludes that Tylenol must work.

Yes, specifically the real Tylenol (in our case “legitimate” acupuncture) did have some effect, but the effect was equivalent to the one produced by the fake Tylenol pill (in our case sham acupuncture). In science, and in medicine more specifically, if the effect that you propose cannot out-perform placebo, there is no effect (not the one that you claim). Acupuncture does do something for people, but it is not because of qi, ancient body maps, or pressure points. If your brain can recreate the effect of all this ancient wisdom, simply by being worked on by someone who just looks the part (to create the ritual sensation), and placing needles where ever they want (not following any of the procedures), the procedures do not work.

Another example:

  • Group 1 receives treatment A, which claims to cure your cough when I place my hands specifically on certain ancient energy points on your chest.
  • Group 2 receives treatment A as well, but this time I will place my hands anywhere, with no regard for any ancient rules or procedures.
  • Group 3 receives no treatment.
  • If both group 1 and 2 experience the same relief in their cough, this does not mean that treatment A works. If it does not work through the modality that you said it works through, even if it is based on thousands of years of practice, not beating placebo means your treatment does not work.
  • In summary, if a complete novice, say myself, can create the same effect with your treatment with no training, schooling, or knowledge, it does not work the way you say it does. And furthermore, if the only effect it has is equivalent to placebo, this means the treatment has no real value and could really be any treatment that creates a placebo effect.

Again, my problem with acupuncture is that you are paying out of your nose for something that could be replicated for free. You are paying for the ritual, or the experience, of acupuncture and not an effect unique to acupuncture itself (because the same effect could be achieved through a fake ritual). I have made various claims without substantiating them, and I will present the evidence below.

Finding a Needle in Your Face-Stack

Let’s begin with a study published this April about the effectiveness of acupuncture:

The study, from the M. D. Anderson Cancer Center, tracked 455 patients with painful knee arthritis who received either traditional Chinese acupuncture or a sham treatment (by sham here they mean either placing needles where ever they wanted, or simply pressing needles into the skin without penetration). A control group of patients was put on a waiting list for acupuncture treatment. Patients were told only that the study was comparing a traditional vs. nontraditional form of acupuncture.

Compared to people on the waiting list for treatment, both the real and sham acupuncture groups had statistically significant reductions in pain, averaging about a one point drop in pain on a scale of 1 to 7. The researchers also found that the enthusiasm of the person inserting the needles had a small but statistically significant effect. Patients reported slightly more pain relief when they were treated by someone who said “I’ve had a lot of success with treating knee pain,” compared with a practitioner who took a more neutral stance, saying “It may or may not work for you.”

Now listen to how they reported this result:

“The results don’t mean acupuncture doesn’t work, but they do suggest that the benefits of both real and fake acupuncture may have something to do with the way the body transmits or processes pain signals. Other studies have suggested that the prick of a needle around the area of injury or pain could create a ‘super-placebo’ effect that alters the way the brain perceives and responds to pain.”

Of course the results mean that acupuncture doesn’t work! If the fake treatment works just as well as the real one, that means the treatment has nothing to do with your methods or procedures! Because the ritual is so integral to the treatment, and becoming an acupuncturist involves much training and money, if the training and procedures have nothing to do with the benefit, you have completely wasted your time (and money)! You could train a nurse in probably about half an hour to stick needles in a patient at a fraction of the cost for the same benefit.

Furthermore, concerning another study, Professor Henry McQuay, professor of pain relief at the University of Oxford and member of the Bandolier group that looks at the evidence behind different medical treatments, said:

“The great bulk of the randomized controlled trials to date do not provide convincing evidence of pain relief over placebo”.

That’s where he gets it right, but then the article quotes him out of context:

“Some people do report that acupuncture makes them feel better”.

Which is anecdotal evidence, and if you don’t know already, anecdotal evidence is purely subjective, non-scientific, and based upon no tangible evidence. A person saying how they feel after a treatment is little to no evidence at all to if the treatment actually does what it claims to do (because of the blinds of the placebo effect). Basically anecdotal evidence is a story from a non-scientific/emotional perspective, and therefore never considered proof (like  how two different people will see two different figures in the same cloud). All of which means that the quote above is useless. It is something said by those with little to no proof, and that is exactly the case here.

Another Study:

“Fake acupuncture works just as well as the real thing in relieving migraines, scientists have found. In a study of more than 300 patients, both genuine and sham acupuncture reduced the intensity of headache compared to no treatment at all. But real acupuncture was no better than needles placed at non-acupuncture points on the body, the Journal of the American Medical Association reports”.

The overall results of independent studies (not run by acupuncturists themselves) are conclusive to say that acupuncture is not effective beyond placebo. I could give you an acupuncture treatment that was just as effective as one from an 90-year-old Chinese grand master. Yes it has an effect, but the effect that is something that is produced from simply believing that the treatment will work. It follows that if you are paying way too much for the treatment, paying purely for the placebo effect that it gives you, you should seek something more legitimate for your pain relief. But how come so many people still use it and believe in it?

But It’s Thousands of Years Old! [So What?]

I know many people who would disagree with what I am saying in this post. Let me be clear, I have no pre-meditated agenda to abolish acupuncture (but it would be nice), I have simply evaluated the evidence and seen that acupuncture does not work. Why do people insist in flying in the face of evidence? A couple of reasons:

  1. They have done it for years and the effect (placebo) is all they need to believe in the treatment.
  2. It is from ancient China, used for thousands of years, that makes it fact. Right?
  3. They think, “How could so many people be wrong about it?”
  4. They trust “alternative medicine” because they think it is more natural than western medicine.

Let’s take them one by one:

  1. People in category one are habitual users that are ingrained in their ways, willing to pay time and time again for something that has had an effect on them. I don’t think they would care if it was fake or not [it is]. This simple scientific ignorance is enough to make them happy. This however, enforces the distrust of science in other areas of their lives, and promotes bad science (like the “it’s natural, so it’s better” fallacy). Their anecdotal evidence is foundation enough, and critical thinking be damned! Is their hope for category number one? If they care enough to learn good science, maybe they can be persuaded to save some money and free up a little precious brain space. Otherwise, we have to let them go (but still fight the ignorance (ignorance in the kindest sense, let’s say being uninformed)).
  2. This is the classic “it’s been used for a long time so it’s true” fallacy. I think people in category two can be persuaded to rethink their position on acupuncture. Perhaps an example like bloodletting, a medical practice using leeches to drain your blood and therefore your illness, used for a very long time, will show them how even the best ideas at the time should evolve with changing evidence. Maybe the fact that acupuncture has gone so long without evolving is because it isn’t based on science at all [hmm?]. Sure it has been around for a long time, but for most of that time no one actually tested to see if it actually worked, so does that mean it still is legitimate in the face of modern testing (that turns out to be negative)? Nope.
  3. People in category three stumble over the argument from popularity fallacy (like balance bracelets ,astrology, homeopathy, etc.). Just because something is popular, does not make it true. Stuff like the burning of witches happened because of this fallacy regarding magic and witchcraft. That all seems silly now, but you can see the parallel in the logic. Perhaps acupuncture will someday seem silly for all the claims it has made. I’m not saying acupuncture has gotten people killed, but similarly everyone in Salem just knew that some people used magic spells and curses, and how could they all be wrong?
  4. The people in category four place trust in alternative medicine over conventional science-based medicine, and this is definitely not founded upon evidence. It is something that people seem to be drawn to in our society. Because there is no real evidence showing that alternative medicine is more effective, or does anything really at all, it must be that the allure of a “natural” product is too great for them to resist. It allows them to be in a certain club, exclusive from all those who aren’t “one with the Earth” or some nonsense like that. The unfounded trust in alternative medicine is then based on a cultural bias towards the underdog, the exclusive, the somewhat mystical. We as human beings are predisposed to be enthralled with that which we do not fully understand. We feel compelled to make sense of it, and feel special when we take part in it. This psychological predisposition, then, creates a bias towards the alternative, which leads to something like the alternative medicine movement. However, this should be separate from the harmless kinds of biases we have as humans because it directly contradicts science based-medicine.

Taking Medicine Seriously

When it comes to medicine, we can not afford to have a bias that discounts evidence in our scientific world. It is imperative that in medicine we have proof for our treatments and can back up our claims with science. Something like acupuncture only defeats that purpose, making it harder for real doctors and practitioners to advance the study of legitimate medicine. With a little bit of knowledge, we can move past the fake treatments such as acupuncture, and evaluate the other claims of alternative medicine to see if they have something to offer us. But if the treatment is discredited, we must move on in order to pursue the true cure for what ails us. Alternative medicine may have components that are worthy of modern medicine, but like with acupuncture, if it is shown that is does in fact have nothing to offer, people have to think critically and change with the evidence. Because sticking to a treatment that is thousands of years old and discredited by science is simply stone-age thinking.

We, The SBL Jury, Find Acupuncture Guilty of PseudoScience in the First Degree