Is Accupuncture Punctured?

Is Acupuncture less effective if you don't believe?

Acupuncture is a pre-medical scientific treatment which is derived from ancient Chinese medicine. The ‘art’ of acupuncture is the insertion of fine needles into ‘acupuncture’ points on the body for therapeutic uses. The theory (the most credible of many) goes along the lines of using the points to produce endorphins using the underlying nerves in the skin. This is used to treat a myriad of symptoms from back pain to anxiety and asthma to diabetes and cancer.

It is argued that it is suitable for use and does work for treatment in patients, including on the NHS website, which claims its use for back pain is suitable because there is ‘evidence’ as recommended by NICE – which is extremely controversial and highly disputed as many Cochrane reviews find there there is no evidence. The way many of these studies are carried out are a subject of great disparity. Most of the evidence is contradictory saying that the results are no better than placebo or saying that it is better than actual medical interventions. Clinical research uses a null hypothesis, either medical intervention works or it does not work. The trail puts burden on proof on the evidence it finds or does not find. When you read this, bare that in mind. I will talk about studies having positive effects and negative effects. If one study has a positive effect and 9 have negative effects, it doesn’t mean that it there is zero effect. It means that the likelihood is smaller of the thing in question having an overall positive effect.

Simple Studies with Simple Bias

It works because they don’t know how it works. With that track record, how can it be said to not work? How Indeed, well, lets take a look at that thing called ‘evidence’. Last year, there was a study published in Ednocrinology titled: Effects of Acupuncture, RU-486 on the Hypothalamic-Pituitary-Adrenal Axis in Chronically Stressed Adult Male Rats. I choose this study as it is referred to a lot across the internet and in the media as ‘the golden goose’ as to how acupuncture works, but is it really? You can access the PDF of the entire paper here and read it for yourself.

This occurs all to frequently with the realm of acupuncture, a study looks at something being prodded with a needle and to assess psychological outcomes is sprayed across the internet as proof as to the functionality of how it works. The study itself looks at two experiments involving rats in different groups; testing control, stress, false acupuncture and acupuncture. If you look at the study, one of the major things you will notice is that none of the rats are actually receiving acupuncture. They were receiving a shock through a needle, known as electroacupuncture – which is as ridiculous as it sounds. The authors assert that their data shows that electroacupuncture lessens the effects of stress caused by cortisol influx in the body. There are a total of 42 subjects, 7 in the control and stress sample groups and 14 in the remaining 2 of the 4 groups. This was a completely unblinded study; the researchers knew which rat was receiving which treatment. With note a lot of data points and an unblinded study – does this even show anything at all?

Let’s look at the results themselves; there are minuscule differences between the actual groups. We cannot conclude that there is a difference between false electroacupuncture and actual acupuncture. This is because the researchers mask the results behind statistical trickery. They say that there is a statistically significance between the control and the electroacupuncture and the difference between the control and the false electroacupuncture was not significant. The difference between electroacupuncture and false electroacupuncture isn’t mentioned, an all to common theme you will see. This study offers nothing really to the world of the pseudoscience of acupuncture, the statistics are incorrectly represented, it doesn’t show ‘how acupuncture’ works – it can be argued that because it uses electrical currents, it isn’t even acupuncture. How much belief do you have in the procedures that you have to clutch at non-existent straws to give it credibility?

Reviews

So, that is just one of the studies, if not the most popular one. Which shows nothing, so let’s look at the bigger picture. In April 2011 Edzard Ernst published a mass review entitled: Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews. The authors reviewed all systematic reviews published in the prior 10 years, exhausting the list of 57 systematic studies. Cochrane release many reviews on the subject, from specific aliments such as headaches and infertility to more widespread views. It appears very little evidence is brought up.

Meta analyses of positive trials have found small differences between the real and fake acupuncture, as seen with the Effects of Acupuncture, RU-486 on the Hypothalamic-Pituitary-Adrenal Axis in Chronically Stressed Adult Male Rats study dissected earlier. A review published in Biomedical Journal in 2013 looked at 13 trials which involved a total of 3025 patients. All of the patients were treated with acupuncture to aid a variety of ailments. There were small differences noted between the fake and real acupuncture, but greater differences were noted between the acupuncture and no-acupuncture group. These groups of course were not blinded. This again, can be demonstrated in a study published in Arch Intern Med who looked at 29 trials with a total of 17922 patients. The results showed acupuncture was better than sham acupuncture with very little difference between the two, so much that it lacked any statistical significance.

What’s the harm?

If you are thinking it is its just needles and placebo is a good thing then there is ‘not a problem’ as it can’t cause any harm, keep reading. Because even the slightest bit of pseudoscience can have damaging effect.

Chinese acupuncturists recently released a review of all the adverse events involving acupuncture within Chinese literature. They found a total of 1038 cases, in which 35 people had lost their lives. The adverse effects ranged from haemorrhages to pneumothorax. Let’s recall where acupuncture comes from, China. This is coming from literature that is completely biased, meaning to favour acupuncture. I can only assume that many cases are largely unreported, probably seen as a ‘small side-effect’. In 2013 another review was published on the vascular problems caused by acupuncture. A total of 31 cases were reported with three deaths and reports of thrombosis, aneurysms, compartment syndrome, internal bleeding and ischemia. In April 2011 a review showed that 95 cases were published involving serious medical adverse effects, of which included 5 deaths.

It would be quite biased of me to say that this shouldn’t happen because medical procedures carry no risks. Even the simplest of procedures carry dire risks and these events are seldom. But with medical procedures, we have a valid and backed up statistical program. We have no idea how many people are actually being injured from these procedures, there isn’t exactly a huge follow up to assess the risks and benefits.

Conclusion

Acupuncture pressure points are complete fiction. They have no scientific basis, nothing supports their existence. At all, they are completely made up. As I have moved to a new town I have noticed that there are more and more of these kinds of stores around me, which is very depressing. There are a total of three acupuncture centres, one of which claiming to be a sports therapist the other two acupuncturists. The damage and fatalities caused by acupuncture are admittedly rare, but it is unknown how rare and how many problems have been caused. When I was reviewing the evidence linked to acupuncture I got into a few arguments, the best of which was: “Maybe a little search of Google Scholar is required” which pretty much sums up the world of acupuncture; google the response you want. Publication bias is a massive problem in alternative medicine which can be easily demonstrated with acupuncture. It is exceptional the amount of studies I read where I have googled the author and they just so happen to practice acupuncture themselves. I have no doubt this will not go away and die-off like some other pseudoscience that lose traction. I think this will be around for many many more years to come and continue to produce little to no evidence of it’s clinical significance. To put it in the words of Steven Novella: this will be tolerated as a voluntary self-imposed tax on the gullible, for as long as governing bodies choose to not step in to assess it.