Acupuncture?

Cecil's Columns/Staff Reports
1

Much as I hate to disagree with a properly cynical point of view on something as goofy as acupuncture, I feel I need to put forth some information on the subject that I feel has been overlooked.

While it’s undoubtedly true that the whole “qi” thing is unscientific at best, it must also be recognized that this isn’t a whole lot different than explanations put forth for a lot of things today that doctors still don’t understand. This is especially true when you consider how old it is; it probably seemed like pretty good science at the time.

All that said, the real issue here is not what people “think” acupuncture might do for you. There are just as many BS claims for acupuncture as for chiropractics, but I don’t think most people would argue that a good chiropractor can’t help your bad back feel better. It’s the same with acupuncture. What’s the core purpose of it? As far as I’m aware, it’s mainly useful for alleviating pain.

Okay, so does it work at helping pain? The overwhelming majority of people studied report that it definitely does. That the mechanism of this relief is unclear doesn’t make it any less effective.

But that’s not really what I posted this to say. What I really wanted to report was that despite claims that there’s no proof acupuncture works, I believe that’s flatly untrue. In fact, those who think so simply haven’t looked in the right places. Where are those places? Veterinary medicine! I personally have seen arthritic horses regain so much range of movement that it’s like watching them get 5 years younger in a day. It’s so effective that many people regularly have their horses treated with acupuncture for relief of pain and arthritis. I’m not sure how it works, but I don’t think a horse probably suffers from a placebo effect either, unless they’re a lot more clever than they’re letting on. I’ve also heard this same thing from many other people, and I remain astonished to this day that outside the horse world this fact is still widely unknown.

It’s not a huge thing, but knowledge is knowledge and I think people should know.

Thanks for reading! :slight_smile:

2

Link to what I presume is the article in question.

Actually, I’ve seen skeptics take on chiropractics as well, especially for some of the more outrageous claims that some chiropractors make. So, might not be the strongest argument you could make.

The trouble is that taking a sugar pill works in some non-zero number of people who are told that said sugar pill is actually a very powerful pain reliever.

-XT

3

Examples? Seems to me that medicine stopped using fanciful explanations for poorly understood phemonena a very long time ago.

In fact, the “mechanism” seems to be incredibly unimportant, since “sham” acupuncture has been shown to work as well as the “real” thing.

Placebo effect can be powerful - the unresolved question is whose placebo to use in what circumstances, what’s cheapest and what’s safest.

Apart from your (or others’) testimonials, what’s the evidence for this?

People claim to have seen wonderful results for chiropractic, acupuncture, homeopathy*, reiki and lots of other woo applied to animals, and what this overwhelmingly suggests is that they are projecting their hopes onto animals and misinterpreting the results.

*yes, there are alleged professionals who think that water is a cure-all.

4

I’m timidly raising my hand:

I have had acupuncture treatment for relief of pain in my left foot, hip, and the thumb joint in my left hand. The practitioner is a person well known to me, who went to a full time school for three years studying Asian medical treatments.

I don’t know why it works for me but it does. The practitioner himself is rather serious about his work, but makes no “outrageous claims” as to it’s effectiveness. He doesn’t see it as a substitute for Western medical care, just an alternative that can work together with it. I used to take a lot of ibuprofen for my pain, now I rarely do. That’s all that matters to me.

I’m not saying that my experience would be what everyone would have, or that acupuncture works for everyone. And as with any other health care professionals, there will be acupuncture practitioners that DO make wild statements about how effective it is. To be perfectly frank the first time I went I was pretty skeptical, but since my treatment is free I thought, “what have I got to lose?”

I am also under the care of regular Western style MD’s. I see a GP and a urologist. The acupuncturist knows this and it makes no never mind to him.

I can’t and won’t make claims that acupuncture will work for anyone. All I can do is state what I have experienced.

5

Hi XT, thanks for replying! I do have a couple quibbling points about your reply though…

Actually my whole point was that there are lots of BS claims about chiropractic. I’ve even seen a poster in a chiro’s office that claimed regular adjustment could eliminate ear infections in children. Really! But outrageous claims about fringe benefits don’t necessarily mean that it’s not effective at helping people with back and neck pain. Maybe I should have elaborated on the point a bit if I was unclear, but what you’re saying is actually the same thing I was talking about.

On the subject of placebos, I believe I addressed that later. Do you really think horses move better after acupuncture because they believe the vet made them feel better? I think it’s more reasonable to conclude that they really do feel better.

Besides, what does it matter that the placebo effect exists in humans? You could do a clinical test for aspirin, and you could observe the same effect in the control group there. Would that invalidate the overall conclusion that aspirin is effective in alleviating pain? No. It’s a well-known and quantifiable effect that’s easily adjusted for in most cases. You can’t just write something off because it’s possible that huge numbers of people supposedly are so suggestible that they think acupuncture has helped them with some kind of pain. That’s just as irresponsible as assuming it to be highly effective from a small sampling of people who all use it regularly anyway, and is just about as useful.

I don’t mean to rant, but this really does seem to ignore the main point. Acupuncture’s obvious effectiveness in animals is at the least very strongly suggestive that it may be equally effective in humans, if not outright proof that at least for pain relief it definitely can be effective. Obviously not everything works the same way for all people, and pain is a very broad category and can have literally hundreds of different causes. But if something works, it should be in the toolbox; especially when it’s something like acupuncture or chiropractics, which have such minor chances for side effects. Personally if I had some kind of chronic pain, I’d rather try one of these things first before breaking out the oxycontin.

EclipseMN

6

From an anecdotal perspective, my sister is an acupuncturist and Chinese herb(ologist) and accredited in 2 states. She is a strong believer in acupuncture (and took extreme exception when I emailed her a link to Cecil’s article :p). She has encouraged me to have acupuncture treatments for years, and due to chronic pain in my lower back and in my shoulder I broke down and went for a series of treatments (30 treatments over many months in all) from a practitioner she recommended about 20 years ago.

The result? It did zero good for me as far as I can tell and actually made my shoulder worse (it was also one of the most painful things I’ve ever had done to me…not from the needles but from the electrical stimulation that caused the muscles in my shoulder to jump, increasing the pain by a hell of a lot). I WANTED this stuff to help, since I was in a lot of pain at the time yet I still wanted to do the sports I loved at the time. I was unable to play tennis, golf, volleyball or practice martial arts anymore without extreme pain.

But it didn’t work. Not even a little bit. What worked? Drugs. Shots. Surgery. Specific exercises designed to help under doctors supervision. Treatments. And, in the end, figuring out that my body was too beat up and old to continue at the pace and levels of activity I was trying to force myself to maintain.

Today I’m pretty much pain free and have essentially full mobility. I sleep pain free.

Anecdotal information, to be sure. Everyone reacts differently to meds or treatments. No doubt about it. But I’ve seen no actual evidence that acupuncture does more than perhaps causing the body to release endorphins…which is the bodies natural pain killers. And that’s pretty weak. Other than that, for me it’s going to take extraordinary proofs for the extraordinary claims of acupuncture or any other woo based medicine.

I am happy that my sister makes a good living treating people and helping them out, and that they believe in her skills. It puts food on their table. Ironically, my brother in law is an accredited chiropractor. :stuck_out_tongue:

-XT

7

The trouble here is that it’s difficult to tell the pain level in animals. Animals have a naturally high pain threshold. And the placebo effect that might be going on here is the people running the tests and interpreting the animal enduring the pain as having a positive reaction to the acupuncture.

If you have real, solid, scientific studies about animal testing of acupuncture as a pain remediation method with some sort of viable methodology for making the tests valid (and, hell, showing the pain levels the animal is actually experiencing) then I’m all ears. Feel free to post it, as it would be interesting and may bolster your case here. But anecdotes of this sort of stuff working on animals, or some trials of it supposedly working without ways of showing pain levels with or without acupuncture/pain meds/nothing, plus some sort of double blind (just because they are animals doesn’t mean they won’t detect things from the testers, including anxiety if they are administering a known placebo or inflicting deliberate pain without using what the human testers THINK is some sort of remediation) then it’s just not going to be convincing…to me anyway, FWIW.

-XT

8

I see EclipseMN is continuing to substitute testimonials for evidence, which limits the discussion, but to address a couple of things:

Aspirin as well as other pain relievers have demonstrated effectiveness above and beyond placebo, as well as logical, evidence-based mechanisms for their effectiveness.

Far from being “written off” by mainstream medicine, acupuncture has been the subject of lots of research. Recent high quality studies have tended to show that any benefits from acupuncture are likely due to placebo effect.

Homeopathy also “works” with “minor chances for side effects” - entirely understandable, since water (or the “succussed” variant) is pretty nontoxic stuff.
It should be obvious that the choice is not necessarily between woo (or placebo, if you prefer) and powerful addictive medications. There’s a range of therapies used in pain with varying effectiveness, some of it taking advantage of placebo and “working”, at least for a time, in people for whom other types of placebo or usually effective drugs do not. The problem, as I noted before, involves finding a safe, cheap placebo and being honest enough with patients so they know they’re not employing evidence-based medicine but not so dismissive that they fail to achieve placebo benefits.

Still waiting for evidence of acupuncture’s “obvious effectiveness in animals.”

9

Really? Then you apparently haven’t been paying attention. Have you ever asked a doctor why exactly you should get your baby boy circumcised? How about why a normal pregnancy in a healthy woman ended in an “emergency cesarean”? Do you know how few OBs understand what they’re doing when they puncture the amniotic sac or starting a pitosin drip? How about the exact mechanisms involved in why a baby would be having a reaction to routine vaccines? The same reason I sound like a crackpot bringing these things up: nobody really knows much about what’s going on, though a doctor is pretty unlikely to admit that!

I use these examples because they’re the closest to my own limited experience, but I’m sure there are countless examples out there. Remember, just because they offer an explanation for how something works doesn’t make it right. A lot of the time, they’re just blowing smoke up a handy orifice.

If you think these results are subjective then I might as well try to convince you that the earth is round. Trust me, when a horse can hardly lift its back legs in a jog before treatment but moves normally an hour later it’s not wishful thinking.

EclipseMN

10

I’m hugely skeptical of acupuncture, in all of its forms (needle, pressure, electro, etc.) mostly due to the alleged mechanism. I think this is the main thrust in Cecil’s article. That said, there are a fair number of studies showing acupuncture, in certain situations, to be efficacious beyond placebo effect.

In the end, though, all the studies were for temporary relief - acupuncture is not actually helping to fix the problem. In terms of actually helping patients (efficacy and predictability [acupuncture doesn’t seem to work for some folks]), I think it’s undeniable that Western medicine is superior.

The occasional efficacy of acupuncture in these studies suggests, to me, is that there’s a mechanism we don’t yet understand. One proposed mechanism I’ve read is some sort of “A-delta nerve fiber stimulation” (which I don’t propose to understand)*. Jackmannii, the mechanism does matter because sham acupuncture, where a needle is inserted (but in the wrong place - as opposed to ‘false insertion’ acupuncture - ), as a control against placebo doesn’t tell us a whole lot.

*The mechanism of acupuncture analgesia: a review - ScienceDirect, if curious

11

It could, however, be dumb luck. That’s why we want to see research, preferably blinded, randomly-assigned treatment research studies published in reputable, peer-reviewed journals. Else you might just be throwing your money away for no reason.

12

Which of these situations involves anything remotely analogous to “qi”, or “humors”, or other fanciful explanations for perceived physiologic reactions/responses to therapy?
I would also point out that for procedures such as circumcision and caesarean section there is a healthy ongoing debate within medicine and changes in practice occurring. As for acupuncture, how many of its practitioners have been willing to admit that its central basis and the myriad claims made for it are unsupported by evidence?

Good luck finding them.

I do not trust your testimonials, any more than I trust testimonials for veterinary homeopathy, veterinary reiki etc. Solid evidence is what counts. I gather you have none to present.

The “earth is round” analogy falls flat (sorry) because there is good evidence to back up that belief (and which contradicts the evidence of our eyes that the earth is flat).

It tells us that the whole rigmarole of “qi” and “meridians” is likely to be bullshit. And when the needles (or pointy objects used to simulate them) don’t even need to pierce the skin to have an equivalent effect to acupuncture needles, the likelihood of the modality being no more or less than placebo effect increases.

13

EclipseMN mentions veterinary medicine and horses.

I had a young cat crippled with arthritis. She lay almost immobile for months. She would get up only to use the box (bless her little heart). I had to take food to her because she wouldn’t get up to eat – it was pretty painful for her to move.

Her internist (one of the top veterinary internists in the DC area, often consulting with the National Zoo) said, after several weeks of treating her with no visible results, that he could do nothing more. He recommended that I see a veterinary acupuncturist – but not because he thought he could help. He seemed pretty skeptical, but he figured it couldn’t do any harm.

The vet acupuncturist said frankly that there were lots of theories about how acupuncture worked, but no one really knew how it did what he believed it did. He treated my cat once and she began to get up to eat. Another treatment a week later and she began to play and jump and run around again. She never seemed to suffer from arthritis again, and she lived another 16 years.

Okay. That’s “anecdotal” evidence, testimonial evidence if you will. But it is evidence. The medical records exist, and I would give a skeptic who wanted to investigate the matter permission to read them.

While it is common to disparage anecdotal evidence – and to be sure, it lacks the universal persuasiveness of experimental evidence – it is often all we have to go on. How do you know your mechanic is any good? Did you submit him to a study with several hundred other mechanics and compare the results with those of a control group? Most likely, someone made a recommendation; you followed it; and you were happy with the results. Your experience would be the basis on which you recommended him. The woman who lives downstairs may say the guy ruined her radiator so she had to replace it and he overcharged her. But that’s not your experience, and maybe she’s a little excitable. So you keep going to him because YOUR experience suggests that he does a good job.

I’ll bet that’s pretty much the same dynamic most people follow when they go to any doctor. You go and you get better. The neighbor downstairs says he made everything worse and she’s thinking of suing him.

What doesn’t happen is that you don’t demand experimental evidence that he’s a good doctor before you go to one. You may read about him in an article called “The 100 Best Physicians in the Metropolitan Area.” But what you don’t do is ask him to submit to a study with a control group. And you don’t ask him to give you the names of patients so you can put them in a study with a control group.

14

Apart from the relatively higher stakes involved in trusting your health care to a particular practitioner, as opposed to getting a car fixed: I take my car to a mechanic who (to the best of my knowledge) follows standard industry practices and diagnoses problems accordingly. If my mechanic told me the reason my car’s engine kept stalling was due to bad “qi” and he needed to pound some bolts into the carburetor’s meridians to get it going again, I’d look for another mechanic.

Same as above. As long as my doctor is trained properly with a solid grounding in evidence-based medicine, I figure he has a fair shot at overseeing my health care properly.

There’s a place for anecdote in health care - for instance when good evidence supports a particular treatment, but I might be interested in knowing what problems/side effects other patients who’ve undergone it have reported, and what grades they’ve given a particular doctor/facility that performs it.

Where anecdotes and testimonials so often break down in health care is ignorance of a simple fact of life pertaining to illness…people (and animals) often get better as the disease runs its course, for no apparent reason, or because evidence-based care kicks in unexpectedly. If on occasion when the patient is sickest he is treated with woo, he may well get better - not because of the woo, but because his illness has run its course.* He will likely credit the woo. Similarly, there are plenty of examples (you can find them in testimonials all over the Internet) where people swear their woo practitioner helped them when their physician couldn’t. Delve deeply enough, and it’s often the case that they were getting mainstream care at the same time (but of course it couldn’t be that - must be the woo instead).

*i.e. correlation does not equal causation.

15

Actually, there are quite a few well-accepted behavioral tests for measuring pain (and analgesia) in mammals, especially rodents. Or do you have specific complaints about these tests and interpretations of their results?

I don’t want to derail the discussion too much, but I’m wondering whether you could clarify this.

Well, one report of acupuncture-induced analgesia in mice appeared in Nature Neuroscience just last summer.

The study isn’t available without a subscription to the journal, but Nature devoted some space to its findings last summer,

http://www.nature.com/news/2010/100601/full/465538a.html

For what it’s worth, the report in Nature Neuroscience has spawned at least one follow-up study, which is being conducted right now (at a different institution and with no affiliation with the authors of the Nature Neuroscience report).

16

“You still wake up sometimes, don’t you? You wake up in the dark and hear the screaming of the lambs.”

17

It often is all we have to go on, yes. But not in this case. Plenty of research has been done, and very little of it shows significant positive effect. Anecdotal evidence is a starting point for study, but we left the starting point a long time ago.

A controlled study on the efficacy of a single doctor is of course, too expensive too be feasible given the potential benefit of the outcome. But if that study was already done, by some eccentric billionaire say, would you not look at the results before you made up your mind?

18

Without seeing the full publication it’s difficult to tell, but one wonders whether the study controlled for various factors including mere handling of the mice, whether those who supposedly detected less response to touch and heat knew which mice they were testing (needled or not), whether comparisons were made to needle insertion at the supposed key acupuncture point as opposed to sham acupuncture etc.

As Dr. Ernst notes in the Nature report, this is a long way from deonstrating clinical efficacy of acupuncture for pain relief in humans - or in animals, for that matter.

Responding to those who know that animals they’ve seen responded fantastically to acupuncture is as difficult as responding to people who know that they or someone else’s medical problem disappeared after the faith healer did his thing, or that their child became autistic immediately after vaccination. It doesn’t mean they’re lying, but that their interpretations are open to question.

19

Where’d this idea come from that animals aren’t subject to placebo effects? They may not understand the treatment being offered, but they may still show improvement from being ministered to, from receiving caring attention, or from trying harder to look well because it’s what they think the humans want.

Even if there is real improvement after a treatment, it doesn’t mean the treatment had a positive physiological effect.
Powers &8^]

20

I won’t bother responding to individual comments due to the number of them in here (quite a few!), but I do have some points.

I think people are getting too caught up in details here. Does it really matter what the exact testing methods are to determine whether mice are in pain? Do you also question the exact methods used to determine that those reporting improvement were probably subject to a placebo effect? Ready acceptance of one point of view and automatic dismissal of another is not objective, especially when one takes the additional step of assuming one knows the relative value of all involved sets of data.

Once again, you may say all day and night that an observed improvement in an animal is subjective but this is just a dead end and really serves no useful purpose. I could just say you obviously haven’t spent much time around these animals, but that’s not useful either. In truth it really is no different than trying to convince someone the earth is round. Of course there’s proof of this, but if you’re not willing to accept it as fact there’s not a whole lot I can do to convince you. I could try to convince you that the world’s glaciers are melting and even show you photographs, but if you’re dead set that this is all a scam there’s nothing I could say to change your mind about it. People dismiss evidence all the time, and the existence of a scientific study does little to change people’s minds if they’re already emotionally invested in one point of view over another.

I posted this topic for one reason and one only, to tell people that there is in fact evidence that acupuncture actually does something, at least for some and at least some of the time. This evidence is in veterinary medicine. I’m perfectly well aware that this is anecdotal, but alas I do not have a university grant stuffed in my back pocket to fund a study. And if I did, I doubt this is the subject I’d spend it on… and I think that’s kind of the point. Who is going to fund this? Where’s the payoff? I was glad to hear from Tammi that there actually has been a study like this recently, I guess I missed that one, and I’m a little surprised they got the funds for it. We’re used to big studies that involve thousands of subjects and sometimes span several years, but these are done for big financial incentive. There is no such incentive for something like acupuncture. Sure, maybe private practitioners would benefit from a positive finding, but is there a single funding source that stands to gain? Not that I know of. However, the lack of a massive experiment does not mean it’s bunk, it just means we don’t have numbers for it like we do for viagra. Truth and data are not the same thing, one is only an indication of another and is always open to interpretation. And just to be clear, what I’m saying here is that a real study is merited and should be done. I hope Tammi’s is comprehensive, but I’m not optimistic for the reasons given above; where’s the money for it?

And finally, the hocus pocus factor (a good a term as any). Just because the traditional explanations for something like acupuncture are obviously invalid doesn’t mean it doesn’t work. You may recall there have been explanations like this for just about everything at some point or other. We used to think the personality/soul was housed within the heart. We also used to think that lightning was direct retribution from the gods or God. These explanations have been replaced once the actual mechanisms involved were discovered and adequately explained. That this hasn’t happened for something like acupuncture demonstrates only one thing for sure: we don’t have a real explanation for it. Does that mean there isn’t one? Of course not. We also don’t really know how gravity works, but we know for sure that it does.

We’re not that sure about acupuncture, obviously. But just because there are definitely quacks out there, and outrageous claims of the benefits it can provide, this doesn’t mean it’s totally bunk. There is actual evidence it may work in some cases for pain relief (yes, temporary relief. Are you aware of any other kind?). This should really be studied more, because if it’s true it could really help people.

Just for the record, I’m not about to go and try it; needles give me the heebie jeebies! I don’t actually know any human who has tried it and I don’t know anyone who practices it. I have no emotional investment in the subject at all, except that I don’t like unnecessarily dismissive attitudes on the basis of “not enough proof” or “not good enough proof” or “I don’t trust that proof”. That kind of thing has gotten us into lots of trouble in the past and present. I know this isn’t one of those important issues, but the attitude is the problem, not the specific issue of the day.

EclipseMN