Acupuncture is one area of alternative treatment which has apparently gained widespread support, but questions remain about whether it actually does any good.
Acupuncture evolved from primitive bloodletting rituals to the insertion of needles into points alleged to lie on lines called meridians. Acupuncture needles can be twirled or electrically stimulated and, in addition, a burning herb can be applied to the acupuncture point (moxibustion). Acupuncture points can also be stimulated with laser light. It is even claimed that the ear contains an inverted foetus pattern (homunculus) which can be used for treating disease in distant organs.
There is no anatomical or physiological basis for the existence of either acupuncture points or meridians. The concept of the auricular homunculus is a scientific absurdity.
There have been extravagant claims made for the success of acupuncture treatment. A common finding is that the most extreme claims of success are made on behalf of the most poorly designed trials. Because acupuncture involves needling of the body, it has been difficult to perform adequate double-blind placebo controlled trials. Nevertheless, careful studies have contradicted many of the claims made by the proponents of acupuncture.
One controlled study showed that electroacupuncture of the ear to treat chronic pain was no more effective than just lightly touching the ear, despite claims of effective treatment for such.
Some have argued that acupuncture analgesia can be explained by suggestion in the same manner as hypnosis. He found no discernible difference in the behaviour of patients whether operated on under acupuncture anaesthesia or hypnosis. This suggests that needles are unnecessary and would also explain the apparent success of laser stimulation of acupuncture points.
Following its evolution from blood-letting, acupuncture points numbered around 365, but the number has increased to over 2,000. Many published charts of the points and meridians do not agree with each other and this lack of specificity would explain the success of random needling. Despite thousands of years of use in China, the Emperor removed acupuncture from the curriculum of the Imperial Medical College because he viewed it as a barrier to the progress of Western medicine.
Since its introduction to the West, acupuncture has undergone many revivals, complete with extravagant claims of disease treatment. In 1822 the editor of a medical journal wrote,
“A little while ago, the town rang with acupuncture, everybody was curing incurable diseases with it; but now not a syllable is said upon the subject.”
The latest revival of acupuncture followed Nixon’s visit to China in 1972. He and his entourage were treated to dramatically staged examples of operations under acupuncture anaesthesia. Reports of these operations were grossly exaggerated and took no account of the published historical evidence of surgery being done in the West without any anaesthetic at all. Professors Geng Xichen and his colleague Tao Naihuang denounced surgical acupuncture as a myth and a hoax.
Acupuncture anaesthesia is not as commonly used for surgery in China as is often claimed. It is not applied to emergency surgery and, when used on carefully screened patients, is often used in conjunction with local anaesthesia or narcotics.
In New Zealand, approximately 14% of doctors practice acupuncture on the basis that 3,500 years of clinical observations by the Chinese are reliable evidence of its efficacy — the same could be said of astrology or the belief in a flat Earth.
Acupuncture has been introduced in such a way that unproven assumptions were made about its effectiveness. Instead of being experimentally evaluated it has become widely used for an absurd range of clinical indications.
A huge scientific literature has arisen in support of acupuncture, such as studies purported to show improvement in asthma symptoms following acupuncture treatment. However, when the studies were repeated by asthma specialists, the claimed improvement could not be duplicated. The acupuncture literature is an example of how people will always find support for what they believe in.
Parsimony refers to the philosophical process of checking whether some new effect or phenomenon can be explained by current knowledge. Acupuncture analgesia can be explained within the paradigm of contemporary conditioning theory. Other theories suggest acupuncture stimulates the production of endorphins, reducing pain. However, this sort of pain relief can be produced by many other types of hyperstimulation, without using needles or requiring meridian points or flows of “chi” vital life force.
When acupuncture is administered by someone who believes in it to someone of a like mind, it is hardly surprising that there is a huge placebo response. One trial claimed dramatic improvements in pain reduction for patients with rheumatoid arthritis when acupuncture points were stimulated by laser. The same improvements were found with the laser switched off!
It has been claimed that the successful treatment of animals with acupuncture proves that acupuncture is not a placebo therapy. The same arguments have been advanced by vets in support of homeopathic treatment. All this demonstrates is that animals, like humans, are subject to spontaneous and unexpected recovery.
Many acupuncture claims are pure fantasy. One paper claimed that a patient with 96% burns, mostly 3rd degree, made an uneventful recovery following treatment with acupuncture. Publication bias means that only positive trials tend to get reported and published. Since the better-designed acupuncture trials consistently report negative findings (i.e. fail to show any benefit from acupuncture) they tend to be under-reported.
Safety is important and acupuncture treatment can cause serious complications such as collapsed lung and various infections, as well as nerve and spinal cord damage. A survey of almost 200 acupuncturists revealed 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax (punctured lung) and 45 other adverse results amongst their patients. A further concern is that non-medically trained acupuncturists are likely to misdiagnose or fail to diagnose serious conditions.
There is little or no evidence to justify the current widespread use of acupuncture. It should not be funded by the health system. Acupuncture needs to be confined to an experimental setting in order to prove its efficacy and indications.