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A dialogue on acupuncture

vlix

New Blood
Joined
Feb 26, 2004
Messages
10
Below are excerpts of a recent email exchange I've had with a very good friend of mine, "Laggek", who supports acupuncture and regularly receives acupuncture treatment.

I'm throwing this in the group, so to speak, hoping that some of you will provide interesting feedback/criticism/information. My friend knows I'm doing this, and she will probably read this thread now and then, and possibly even participate.


vlix wrote:

F*ck it, I know you don't like to discuss acupuncture with me anymore, but I can't help myself, your assertion that I "cannot understand" acupuncture... stimulated me. I don't like to think that there is stuff I "cannot understand". Sure, there is plenty of stuff I don't understand, and probably never will, but I prefer to think it wouldn't be IMPOSSIBLE.

Here's one thing I definitely don't understand: I don't understand why you find it so difficult to agree that the effectiveness of acupuncture can be tested, and that therefore, its effectiveness SHOULD be tested in order to find out whether it does something, or whether its supposed effects are down to something else. I mean, I'm not even saying (I really am not) that acupuncture doesn't work; in my view, of all "alternative" healing practices, acupuncture is one of the least silly, at least when you forget the utterly implausible yin/yang/meridian explanations. I'm just saying that the odds are against acupuncture being effective, and that the default position on such a matter should be: "it doesn't do anything until you prove it does". I mean, what the hell is so radical about my opinion here? Perfectly sane and down to earth, I would think. What, according to you, do I not UNDERSTAND?? What is so horrible to you about proving that acupuncture is effective? And if it is as effective as you say it is, why hasn't it been done already?

Please, just answer me this: do you believe that it is IMPOSSIBLE to test acupuncture? Do you believe that scientifically testing the effects of acupuncture (not the method!) is somehow meaningless, because acupuncture is inherently unscientific, does not follow the same paradigm as biomedicine, or something like that? Do you believe that the results of such a test prove nothing, because they would not be representative of real-world, uncontrolled application? If your answer to these questions is "yes", then I will acknowledge right here and now that indeed, we will never agree, and I will try not to be provoked by you, no matter how much I LOVE being provoked by you. If however, the answer to these questions is "no", we have much to talk about.

Be honest though, don't just choose "yes" because you want me to finally shut up ;-)

[...]



Laggek replied:

The answer is no. Of course I think it is POSSIBLE to test the effects of acupuncture by what you call scientific means, and I also think that it SHOULD be done, because I think if it WOULD be properly done, even western medicine would accept that acupuncture IS an effective way to treat very many kinds of conditions. Not all, obviously, but neither is biomedicine effective therapy to every condition.

Pleased? If I were of similar mind set as you, I could also dig out studies that HAVE proven acupuncture effective. Because studies that even you might accept HAVE been done, albeit very few of them. I believe the attitude within the biomedical faculty is slowly changing, and more open-minded interest toward alternative therapies will lead to more unbiased research. But the process is slow.

To my knowledge, there is also such a pilot project going on in one of the university hospitals/Faculty of Medicine in Finland (in Kuopio, I think), where the aim is to set up a large scale research project to test various aspects of acupuncture by standards of western science, or what you call simply Science.

Probably similar research is being carried out elsewhere.

The largest corpus of clinical experience with acupuncture is obviously from China, as there acupuncture is one form of treatment included in public health care, and used also in treating serious conditions such as paralysis, and as anaesthetic in operations etc, not just an incompetent doctor or physiotherapist poking needles here and there to relax your muscles or cure your headache, like in Western countries is commonly done.

What I would like to see are studies that indeed concentrate on the effects. E.g. from China it should be easy to collect a large enough amount of data in treating various diseases and pathogenic conditions treated (successfully) with acupuncture, to prove it does indeed work.

To my knowledge also some animal testing has been done with acupuncture, with similar results as in humans, thus excluding an explanation solely based on placebo effect.

But as I said, I don't NEED you to believe or "know" that acupuncture is effective. But I am happy if you are interested and open minded. I still don't want to take on the task of PROVING you anything. If I find relevant studies, I'll send the links your way.

I know you always want scientific proof, statistics etc. I understand that, and you are free to feel that way. For me it is enough proof what I have experienced myself, and what at least 30 people I personally know have reported. E.g. with migraine. If acupuncture is not effective, or is based on more or less just placebo effect, how do you explain at least 10 people I personally know (have to deduct those ten people cannot be the only ones to which this applies, only they are those I personally know), have stopped having migraines completely after having suffered from it for decades? This after visiting the acupuncturist 3-6 times. And the migraines never returned? Would be a rather strange coincidence, if for all of them it just happened to go away for some natural reason right at the time they were treated by acupuncture.

And I know many other stories like this. On many different conditions, including difficult hereditary degenerative conditions. When those patients have gone to their doctor after acupuncture, the doctor has been baffled by the sudden improvement.

Of course my friends and acquaintances do not make a scientifically reliable statistic, but I am sure such a thing could be compiled if there was interest to do so. Do you not understand that a lot of medical research is also based on money and other interests, and not only done based on pure scientific interest or out of interest to help people? In whose interest is it to further research on acupuncture? Not in the interest of people with money.

Besides its other benefits (such that it is chemical free for example, so it does not further stress the liver and other organs of an already sick person), acupuncture is also a very cheap method of treatment. With this I do not mean it is necessarily cheap for a patient in the West, as for acupuncture you do not get any compensation from public health care funds etc, and the acupuncturists also have to make a living, while being heavily taxed. I mean to say that the method itself is dirt cheap: no expensive meds or equipment involved. Obviously the practitioner needs to be well trained, and that is an expense, but currently here only to him or herself, as the state pays nothing for it. My point is, that acupuncture (like some other traditional, effective treatments) would also be a very good supplemental kind of health care in all developing countries, that simply cannot afford to offer high standard western style health care to their people. But, in general, there is less interest in researching stuff that mainly effects the poor/is in the interest of the poor.

Enough said for now. And don't just dismiss everything I say just because unlike you, I cannot (am not willing to spend the time and energy) pull up always some web link to a research supporting my views. I could refer you to some studies, and perhaps one day I will, but do you understand that it would require a lot of effort from me? Both because it is true, studies like that are NOT easy to find, but also because I am not a computer boy wizard, i.e. do not know where to search and how.

[...]



vlix returned:

Brilliant answer, thanks! Now, don't you think we understand each other a little better than yesterday? Don't you think we've made progress? I think it's still possible to learn from and about each other on this subject.

You hopefully understand that I'm not quite as closed-minded on acupuncture as you thought; I'm prepared to acknowledge acupuncture works, I just want to see measurable results.

I on the other hand, am extremely relieved that your answer to my final questions was "no", and that we indeed still have something to talk about. I believe that more than a few supporters of acupuncture would have answered "yes", and I'm glad you didn't.

I would not dare to dismiss anything you wrote, I think you mentioned a few VERY interesting things in your email, stuff that I will need to think about. [...] I'll definitely have to look into those animal trials you brought up, I think I've heard of those before, but I don't remember the details. I also respect and completely understand that you don't want to spend valuable time on research and digging up studies.

Of course I disagree with some of the things you say. For example, I do not think scientific research in alternative therapies is biased towards the position that all alternative medicine is useless. If anything, I believe it may be the other way round, since many scientists who want to test alternative therapies already suspect that they do work and are therefore eager to find positive results. Scientists are only human beings, they make mistakes, and they can be biased, even when their job requires them not to be. Yes, they can be biased against alternative medicine, but they can also be biased in favour of it. This is why it is important to realize that multiple trials by separate groups are necessary in order to obtain credible results.

In addition, it is, I suspect, quite hard (though not impossible) to conduct a truly fool-proof test of the effects of acupuncture. With pills, you can easily test for placebo effect by using fake pills. It's much harder to perform fake acupuncture. This makes proper double-blind procedures difficult to implement.

I also disagree with you on the number of studies that have already been done on acupuncture. You think there are very few. I think there have been quite many already, and as far as I know, most (but of course, not all) of them find no evidence that acupuncture is effective. I have no numbers to back this up, but it's the impression I got from various reading on the subject. I might be wrong.

[...]

All right then, any comments? Does anyone have some information about, for example, the animal testing Laggek mentions? Want to point out flaws in my or Laggek's thinking? Perhaps someone knows more about the number of relevant scientific studies of the effects of acupuncture?

Looking forward to any comments, and in any case, thanks for reading!
 
Laggek asked me to add the following:

Btw, you should add to the forum page, that anyone commenting or presenting studies on acupuncture should specify if they are talking about Traditional Chinese medicine, OR western style acupuncture (trigger points etc). These two are completely different things, although needles are used in both. If a study has been studying the western style acupuncture, it gives no significant information on the efficacy of TCM acupuncture.
 
Though I could be wrong to some degree, I seriously doubt accupuncture actually has any real effiacy beyond borderline placebo effect - and that is only with certain people. Reason? It was originally intended in the context of internal closed-door practices which revolve around vitality - and for those practictioners alone. As a crude analogy, an ordinary person going to an accupunturist is more or less like taking your stuttering Geo to an automotive specialist that works exclusively with engines that use specialized fuels for racing. He may be able to do something a bit interesting to your engine, and you may notice a slight difference when driving, but nothing really helpful.

See my other two posts on the subject, here, and here.
 
Good to see an intelligent debate without rancour. But your friend does not say anything new. I'm not going to answer all the points, but here's a thought. From what both sides say, there is a real problem in finding evidence. Now for the overwhelming majority of orthodox medicines in use today, the evidence is very clear. It has to be, or it would not get a product licence. There has indeed been a huge number of clinical trials of acupuncture, and sadly most of them are rubbish. The good quality ones do not provide a consistent picture. If we went to the regulatory authorities with such a package, what would they say? No prizes for the answer. I am driven to the conclusion that, if evidence is so elusive, is it really there?

Your friend is right that TCM acupuncture is different from Western - in all the TCM journals it is reported to work fantastically well, and in the Western journals it rarely does. Was Marshall Macluhan right? For those too young to know, he was the 60s guru who said that the medium is the message.
 
All I can add is anecdotal evidence. I went to an acupuncturist who had escaped from the communists back in the 40's. She was an 8th generation acupuncturist so I would say she was as real as any. My back problem was not helped at all by her treatment. She did give me some green pills that made me take a massive dump but that's about it. Eventually, I got some MRI's that showed I had two nicely ruptured discs. After a few sessions of physical therapy, I stopped limping and now I'm able to lead a relatively normal life again, but it is because of my physical therapy exercises that I do on a regular basis. Before I went for physical therapy, I went to a chiropractor for a few months and that was another waste of time and money. From my point of view, Western medicine scores +1 and alternative therapy scores a -2.

I have a feeling that only the success stories get printed. When was the last time anyone admitted going in for acupuncture and finding it did not help them? As far as I know, I'm the only one who has admitted this here on the JREF forum.
 
I have a feeling that only the success stories get printed. When was the last time anyone admitted going in for acupuncture and finding it did not help them? As far as I know, I'm the only one who has admitted this here on the JREF forum.
I had acupuncture twice for low back pain (one of the conditions for which evidence is claimed), on recommendation of my GP. Did absolutely nothing. Then I was recruited into a clinical trial using electroacupuncture. Actually the investigators lied to me and I was only getting placebo (the informed consent document was incorrect). That was for neck pain. In fact the back pain was resolved by physiotherapy, and the neck pain by correcting posture at the computer (I threw away reading glasses and changed my contact lenses). If the CAM brigade is so hooked on anecdotal evidence then they can try this for size.
 
What professionl studies have been done on acupuncture and what were the results?
Laggek wrote
I could also dig out studies that HAVE proven acupuncture effective. Because studies that even you might accept HAVE been done, albeit very few of them. I believe the attitude within the biomedical faculty is slowly changing, and more open-minded interest toward alternative therapies will lead to more unbiased research.

I would ask for links to these studies. I am not aware of any professional studies that show acupuncture - of any type - to be effective.
"The NCAHF issued a position paper on acupuncture that asserts, "Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease" http://skepdic.com/acupunc.html
 
I would ask for links to these studies. I am not aware of any professional studies that show acupuncture - of any type - to be effective.
"The NCAHF issued a position paper on acupuncture that asserts, "Research during the past twenty years has failed to demonstrate that acupuncture is effective against any disease" http://skepdic.com/acupunc.html
You should visit Bandolier. There is some evidence for efficacy in low back pain, and especially post-op nausea and vomiting. But even so, most authorities accept that it's not possible to exclude placebo effect. For N & V though, this seems most likely to be a well documented neurological effect. This is because you only need to stimulate the P6 point on the wrist, not a complex pattern of `meridians'. Doctors have known for years that pressing on this point will sometime stop N & V in the recovery room. You don't need to stick needles in. I think there just might be a genuine effect of acupuncture, but it's nothing to do with `qi' or `meridians'. And again, the effect (if it exists) is so elusive that one wonders how useful it's going to be.
 
Asolepius, I visited Bandolier and read the study you suggested
It seems of the studies investigated only 4 were correctly double-blinded and results speak for themselves.
"The inability of the four highest quality blinded trials to show a statistically significant short-term improvement must be worrying for those providing acupuncture services, and for the health services or individual who purchase acupuncture"
http://www.jr2.ox.ac.uk/bandolier/band60/b60-2.html
 
Asolepius, I visited Bandolier and read the study you suggested
It seems of the studies investigated only 4 were correctly double-blinded and results speak for themselves.
"The inability of the four highest quality blinded trials to show a statistically significant short-term improvement must be worrying for those providing acupuncture services, and for the health services or individual who purchase acupuncture"
http://www.jr2.ox.ac.uk/bandolier/band60/b60-2.html
Yes, I just looked at this again also. Note that it dates from 1998. Ernst has published more recent work. I'm just about to leave the office so don't have time to look it up, but you could rummage through PubMed yourself. You could also try Cochrane but the CAM specialism is dominated by Brian Berman who is openly biassed. See Quackwatch for more on him.
 
Seems like there is a good deal of ignorance on this thread. It took me very little time to find one of the very many articles on Pubmed from a British University that shows positive effects of acupuncture with use of the now standard sham acupuncture control....

Ooops... apparently I'm not allowed to post links yet so please go to Pubmed and search for

The efficacy of acupuncture in the treatment of temporomandibular joint myofascial pain: A randomised controlled trial.

Smith P, et al. (from School of Dentristry, University of Manchester.

As a scientist I am not easily convinced by alternative medicine as most of it requires substantiation but from receiving acupuncture treatment for nearly a year I can say that it has definitely helped me, seemingly above and beyond the "placebo" effect (though of course it is difficult to be objective).

If anybody has any questions I'm happy to answer them.
 
I have had acupuncture treatments for psorasis. It worked slightly. Most dermatologists prescribes stuff that did not work for me at all. However the dermatologist I see now has a treatment which works much better than acupuncture. Apparently most dermatologists don't like the treatment I get now because its new but scientifically proven.
 
http://www.nih.gov/news/pr/dec2004/nccam-20.htm

I thought it was common knowledge that acupuncture worked. For some stuff. There was even animal experiments where it was used for anesthesia. How strange.

To be pedantic, I thought that trials on acupuncture had shown that sticking needles into someone has more/different effects than a sham procedure intended to mimic sticking needles in someone. I haven't seen any research to validate acupuncture's focus on sticking needles in particular bits of the body - is there evidence for this?
 
As a scientist I am not easily convinced by alternative medicine as most of it requires substantiation but from receiving acupuncture treatment for nearly a year I can say that it has definitely helped me, seemingly above and beyond the "placebo" effect (though of course it is difficult to be objective).

And my mother said the same for a homeopathic treatment just the other day.
 
I posted a link to a solid scientific study on acupuncture.
http://www.nih.gov/news/pr/dec2004/nccam-20.htm

I know that sometimes people don't want to believe scientific studies, or to have to read them, because science challenges their pre-conceptions about stuff. In fact, that is what a woo would do. Isn't it?

Please provide any practitioners to limit themselves to practices that have been shown to have any validity in a scientific setting?

edit: In looking at the NCCAM site, they are unclear, does the improvement atributed to accupuncture show gotten by improving the flow of Yin or Yang to the knee?

From their site

How might acupuncture work?
Acupuncture is one of the key components of the system of traditional Chinese medicine (TCM). In the TCM system of medicine, the body is seen as a delicate balance of two opposing and inseparable forces: yin and yang. Yin represents the cold, slow, or passive principle, while yang represents the hot, excited, or active principle. Among the major assumptions in TCM are that health is achieved by maintaining the body in a "balanced state" and that disease is due to an internal imbalance of yin and yang. This imbalance leads to blockage in the flow of qi (vital energy) along pathways known as meridians. It is believed that there are 12 main meridians and 8 secondary meridians and that there are more than 2,000 acupuncture points on the human body that connect with them.

Preclinical studies have documented acupuncture's effects, but they have not been able to fully explain how acupuncture works within the framework of the Western system of medicine that is commonly practiced in the United States.9-14 It is proposed that acupuncture produces its effects through regulating the nervous system, thus aiding the activity of pain-killing biochemicals such as endorphins and immune system cells at specific sites in the body. In addition, studies have shown that acupuncture may alter brain chemistry by changing the release of neurotransmitters and neurohormones and, thus, affecting the parts of the central nervous system related to sensation and involuntary body functions, such as immune reactions and processes that regulate a person's blood pressure, blood flow, and body temperature.15,16
 
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