Acupuncture: Getting the point

I’ve frequently written about what I like to refer to as “quackademic medicine,” defined as the infiltration of outright quackery into medical academia, particularly medical schools and academic medical centers. There’s no doubt that it’s a significant problem as hallowed institutions like Memorial Sloan-Kettering Cancer Center embrace nonsense, pseudoscience, and quackery in the name of “integrative medicine.” It goes far beyond MSKCC, however, with Dana-Farber and other elite institutions having apparently bought into the need to study prescientific vitalistic quackery.

One area that’s steeped in woo and has been for a long time is exercise and fitness. I was reminded of this when a reader sent me a link to an article in the November issue of EXPERIENCE L!FE Magazine by Selene Yeager entitled Acupuncture: Getting to the Point. I groaned at the cliched title, but was willing to give Yeager a pass because most headlines are chosen by the editor, not the author. What I was not willing to give her a pass on was the credulous take on acupuncture delivered. In fact, the credulous take was seen in two articles, because the first article was accompanied by an article about acupuncture research by Yeager, Making the acupuncture connection, which inadvertently shows how deep acupuncture has infiltrated medical academia.

The first article, as most such articles do, begins not with evidence but with an anecdote, this time about a man named John Pacharis, who crashed his off-road motorcycle, tearing his ACL, MCL, and PCL — three of the four major ligaments in his knee. Obviously, his knee was messed up bad (my medical terminology), and he needed surgery. He took too many opioids by his account and when he learned he needed another operation:

He began searching online for ideas about how to better manage his recovery and came across a support group where someone suggested acupuncture. “I was very skeptical but figured I might as well try it,” recalls Pacharis. “The first thing the acupuncturist did was put needles in my hands to calm me down and lower my heart rate. I felt an immediate, amazing flow of euphoria. It was like Dilaudid — but obviously so much better for me.”

Pacharis received weekly acupuncture treatments for two months, both to keep swelling under control and to manage pain with fewer drugs. He still gets treated on occasion, and says he’d do more if it were covered by his insurance.

“I don’t know how it works,” he says. “But it definitely works.”

Of course, as I’ve discussed before, there is no good scientific evidence that acupuncture has a detectable effect on chronic knee pain above and beyond placebo, a systematic review by the NCCIH notwithstanding. Basically, acupuncture is a theatrical placebo, all small risks and no real benefit. You’d never realize it from this article, though, which launches right into a discussion of emergency acupuncture, complete with the favored narrative of acupuncturists working side-by-side with real doctors:

“The current opioid epidemic has opened the door for safer, more natural ways to reduce pain,” says acupuncturist Adam Reinstein, LAc. He was hired in 2013 to work in the emergency room at Abbott Northwestern Hospital in Minneapolis as part of the hospital’s campaign to integrate Eastern techniques with a Western medical approach. He’s the first acupuncturist on an ER hospital staff in the United States.

During one shift, he might treat a car-accident victim and someone suffering complications from chemotherapy with the same basic approach. “We look at acupuncture as the first level of pain and anxiety relief,” he says. “Pain, anxiety, and nausea are the big three I treat most in this setting. In many cases, I can help patients start to feel better in the first two to five minutes.”

I can tell you that if I’m ever in a car wreck and land in an emergency room, if I see an acupuncturist offering to stick needles into me the reaction will not be a pleasant one. Of course, acupuncturists like to claim that there’s value to using it in the emergency room, but whenever I look at actual attempts to study its use there, I am inevitably underwhelmed by the results. Yeager notes that there has been a study of the results of emergency acupuncture at Abbot Northwestern Hospital that was very promising. So I looked it up, my intention being to do my usual deconstruction. Basically, it was an observational, retrospective study. No randomization. No blinding. No prospective enrollment of patients. In other words, for a subjective measure like pain it was pretty much a worthless study, and I saw little reason to delve more deeply.

This leads to the propaganda. Yeager first notes that the Kansas Chiefs hired the NFL’s first acupuncturist 23 years ago, that the US Air Force is using “battlefield acupuncture,” and that the VA in Boston is offering acupuncture. Of course, I’v discussed how ridiculous battlefield acupuncture is on many occasions, including the lack of evidence for its efficacy, and just how deeply pure quackery has infiltrated the military, as well as the VA. Unfortunately, Yeager buys completely into the myth of acupuncture:

Though pain relief is still the primary reason many Westerners seek acupuncture, more have discovered what people in China, where acupuncture is part of routine medical care, have long understood: Acupuncture can offer relief from a vast array of health problems, including digestive issues; stress, anxiety, and depression; respiratory disorders, such as asthma and allergies; hormone-related issues like infertility, PMS, and menopausal symptoms; and more. Read on to explore whether it might be right for you.

Of course, what Yeager seems not to realize is that more and more Chinese seek real medicine and reject traditional Chinese medicine (TCM). Indeed, what is considered “TCM” today is in actuality a retconning of several lines of Chinese folk medicine into a seemingly unified whole conducted under the rule of Chairman Mao Zedong. Acupuncture as we know it didn’t really exist until maybe 100 years ago, claims of its antiquity dating back thousands of years notwithstanding. The earliest Chinese texts don’t mention acupuncture, for one thing. For another thing, European surgeons who observed acupuncture and TCM as they were practiced in the hinterlands of China 100 years ago were horrified. Indeed, Mao himself preferred “Western medicine” and eschewed TCM. I’ll just quote one passage from the memoir of a Scottish surgeon named Dugald Christie, who served as a missionary doctor in northeastern China from 1883 to 1913:

Chinese doctors own that they know nothing at all of surgery. They cannot tie an artery, amputate a finger or perform the simplest operation. The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood vessels and important organs, and immediate death has sometimes resulted. A little child was carried to the dispensary presenting a pitiable spectacle. The doctor had told the parents that there was an excess of fire in its body, to let out which he must use cold needles, so he had pierced the abdomen deeply in several places. The poor little sufferer died shortly afterwards. For cholera the needling is in the arms. For some children’s diseases, especially convulsions, the needles are inserted under the nails. For eye diseases they are often driven into the back between the shoulders to a depth of several inches. Patients have come to us with large surfaces on their backs sloughing by reason of excessive treatment of this kind with instruments none too clean.

Acupuncture is believed to have developed from the Chinese version of bloodletting, very much like the “Western” version of bloodletting. This is the “ancient wisdom” of acupuncture, not the fantasy story told by acupuncturists and other believers to credulous journalists like Yeager, who basically accept what they’re told about qi and “life energy” and “energy flows,” in other words, the vitalistic, mystical, religious belief system underlying acupuncture, a belief system with no basis in science, and then write:

Those studies include a meta-analysis of randomized control trials with 18,000 total participants, financed by the NIH and published in JAMA Internal Medicine in 2012. This large study shows that acupuncture outperforms “sham” treatments (where needles are placed at random points or not far enough into the skin) in treating osteoarthritis, chronic headaches, and chronic back, neck, and shoulder pain.

No, no, no, no. That’s the Vickers meta-analysis, and it does not show that acupuncture works for pain. It just doesn’t. Yet every acupuncturist and believer trots this study out as definitive “proof” that acupuncture works for pain as they pontificate about their mystical magical medicine:

Chinese medicine views the body as an anatomical whole, with organs defined in terms of yin and yang. Like qi, yin and yang might sound esoteric, but Kaptchuk simply calls them “convenient labels used to describe how things function in relation to each other.”

Yin qualities are night-like: cool, dark, restful, and passive. By contrast, yang qualities are like the sun: hot, stimulating, vigorous, and active.

When we’re healthy, we maintain a balance of the two. When we have symptoms of illness, we usually have too much of one and not enough of the other. Hormonal cycles of all kinds readily reveal the interplay of yin and yang.

“There is a constant struggle to keep these two in balance, which is the root of all diagnosis and treatment in Traditional Chinese Medicine,” says Boggs. “For example, yin works to cool the body and maintain a constant temperature. So if yin becomes depleted or is insufficient, yang will increase, which increases body temperature.”

She explains how this works during menopause. “Our bodies are typically more yang during the day and yin at night. During menopause you have kidney yin deficiency, so your yang persists into the night and you have insomnia and hot flashes.”

Research bears this out. In one yearlong study of more than 200 women ages 45 to 60, acupuncture treatments reduced hot flashes and night sweats by as much as 36 percent, and improved sleep, memory, and anxiety.

No, research does not bear this out. There is a panoply of studies of acupuncture for menopause, be it natural menopause or menopause induced by the treatment of breast cancer. When carefully examined, they basically show that acupuncture does not work for menopausal hot flashes. And why should it? There is zero biological plausibility.

None of that stops Yeager from trying to convince us that acupuncture meridians are real. She even cites the work of Helene Langevin, who tried to map the anatomy of acupuncture meridians and acupuncture points on cadavers. I’ve discussed Langevin before. Her research has traditionally been—shall we say?—less than convincing.

The last section shows us the true intent of the article, which is to sell acupuncture as a treatment. Not a hint of skepticism having been shown thus far, Yeager dutifully tells the audience how they should only seek out acupuncturists certified by National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), concluding:

Finally, the question everyone asks is: “Does it hurt?” The needles are a very fine gauge, so acupuncture is different from getting a shot. You may feel a brief sting, especially if you’re a bit dehydrated or otherwise inflamed. Once inserted, the needles also may cause slight achy or itchy sensations, but this is rare.

The sensations are almost never as bad as people expect, says Tomás Flesher, LAc, of Three Treasures Natural Healing in Minneapolis, and the relief acupuncture provides usually overrides those concerns.

“For most people, it takes only one treatment to overcome whatever fear or anxiety they have,” he says. “Once they relax and start feeling the power of what acupuncture can do, any fear they did have completely goes away.”

The only real “power” of acupuncture is to separate the mark from his cash.

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Acupiuncture is a system of treatment rooted in the prescientific vitalism of traditional Chinese medicine (TCM). It doesn't work. For anything. As Steve Novella and David Colquhoun put it, acupuncture is basically a theatrical placebo, which is why rigorous studies consistently fail to find a…
I almost feel sorry for acupuncturists these days. Almost. Well, not exactly. Clearly, given the infiltration of woo into academic medicine, acupuncturists are in demand even in the most allegedly "science-based" of academic medical centers. After all, acupuncture is what I like to refer to as "…

From my personal experience I can say that acupuncture is the best treatment for muscle knot pain bar none. If a muscle knot is hit by a needle it instantly releases. I have suffered muscle knots for many years and have tried many things, but nothing else works so good. Doctors I have been to about this problem have no solution at all.

By jack stephens (not verified) on 17 Nov 2016 #permalink

I have a hard time understanding all of these attempts to justify acupuncture scientifically. They always start with citations of a clinical trial (or an anecdote) like they are really in the world of scientific evidence. They throw up some figures and numbers and mimic the style of real research. But then they go onto to explain qi:
Yin qualities are night-like: cool, dark, restful, and passive. By contrast, yang qualities are like the sun: hot, stimulating, vigorous, and active.
That has nothing to do with the clinical trial evidence. The clinical trial evidence shows nothing about qi or yin, nor even yang. Where is the evidence backing this up? Where is the model that predicts yin is cold and yang is hot?
And then they get worse and talk about how acupuncture could solve literally everything that is wrong with you. Then why hasn't it? People used aspirin for years and found it has benefits for heart disease. People used acupuncture for years and ...
It just doesn't seem like the original article was written to convince or persuade anyone that acupuncture is worthwhile but was designed to justify the alreadybheld belief that acupuncture is great.

By Pandadeath (not verified) on 17 Nov 2016 #permalink

I don't like too much the idea of disproving fairies by using clinical trials, but there is something that can be done, if someone is interested enough to make the effort.
Let's consider two groups of patients, each with a disease (A or B) with a different acupuncture treatment (a or b). Patients with disease A and patients with disease B will be treated by professional acupuncturists with treatment a and another group of A and B will be treated by the same acupuncturists with b. In each situation, the acupuncturist is told he is dealing with the disease corresponding to the treatment. At the end of the trial, one can see if the outcome is related to the matching of the treatments.

By Daniel Corcos (not verified) on 17 Nov 2016 #permalink

Orac writes,

"Basically, acupuncture is a theatrical placebo, all small risks and no real benefit"

MJD says,

It's all about the human element (i.e., touch/interaction).

If machines administered the needles, in the absence of the human element, acupuncture would quickly cease to exist.

Although, Disney Corporation is the only organization that could possibly make robotic acupuncture work. My guilty pleasure would be Mini-mouse.

By Michael J. Dochniak (not verified) on 17 Nov 2016 #permalink

My sister suffers from a condition for which there are no real treatments. She tried some of the drugs available and the side effects became intolerable. She was treated for an acupuncturist because she was desperate and she said it helped.

I know it's nonsense and I know she is wasting her money and putting herself at risk for no benefit. But I admit that as much as I hate these fakers bilking people out of their money, I can't deny her something she thinks helps her. I did point out the risks and costs involved, and hope she thinks about it.

But she is the reason I went in to research. People I care about who suffer from conditions for which medicine has no answers are particularly vulnerable. It's hard to stand by and watch.

*by* an acupuncturist, not *for* an acupuncturist. Makes it sound like another part of her condition that needed treatment.

They like to claim that acupuncture is 1000s of years old. I'd really like to see the miracle metal-working that produced the needles used in this. ( https://books.google.ca/books?id=j62mAwAAQBAJ&pg=PT508&lpg=PT508&dq=Nee… ) This indicates that the height of technology about 1000 years ago was a needle between 1.3mm and 7mm thick. The iron and copper needles were thinner then bone, but not by a whole lot. Not something I'd be willing to have jabbed into me.

By Anonymous Pseudonym (not verified) on 17 Nov 2016 #permalink

Pandadeath@2: This precisely fits the definition of "cargo cult science" that Richard Feynman gave in his 1974 Caltech commencement address. Acupuncture isn't specifically mentioned in that speech, but reflexology (another pseudoscientific alt-med technique which has received some Respectful Insolence from our host) is.

You are right about the tell: qi is not a scientific term, so any attempt to define it scientifically will fail. Yin and yang may have some value in philosophy (IANA philosopher, so I don't know either way on that question), but again they are not scientific terms.

By Eric Lund (not verified) on 17 Nov 2016 #permalink

Since we're talking about anecdotal evidence, there's a plethora of it that acupuncture can cause pain and do serious harm. There's even more anecdotal evidence that it's a waste of time.

By Christine Rose (not verified) on 17 Nov 2016 #permalink

I recently wrote to the editors of The Berkeley Wellness Newsletter, a cridible publication (now digital) that I had subscribed to for 30 years or so, which had always presented good solid, evidence based information. I have always kept thier Wellness Encyclopedia on my kitchen shelf as a handy reference for looking up the nutritional details of almost any food. They’ve never been into woo. Then one day they proclaimed acupuncture as a viable thing to try and went on to give advice about getting someone who is licensed and such. When I wrote citing some of Orac’s work, the reply was the infamous Vickers Study. I fired back with Orac’s takedown of Vickers. I was expecting an apology, but instead was treated with, “you people are hopeless ideologues and as bad as those you criticize”. I didn’t even get to cancel my subscription--they cut me off (at least I never received another installment).

So, this is a bit like the recent election and, honestly, nothing can surprise me anymore if it involves the dumbed-down state of most of the population, especially those who truly ought to know better.

I’m tired of fighting. I fear we have lost and frankly, I’m glad I’m old. I’m abandoning the Beagle for a new inland location. I’ll be an illegal, but am hoping for leniency if that’s discovered. It seems more realistic than hoping for a rational response to blatant quackery/nationalism.

By darwinslapdog (not verified) on 17 Nov 2016 #permalink

Yin and yang may have some value in philosophy (IANA philosopher, so I don’t know either way on that question), but again they are not scientific terms.

I am not a professional philosopher either, but I know a few, and my sense is "no." The whole concept beats John Gray in terms of gender essentialism, for one thing.

"I groaned at the cliched title"

Well, if you'd stop needling and sharply criticizing acupuncturists and puncturing their overblown claims, defensive articles like Yeager's wouldn't have to be published.

By Dangerous Bacon (not verified) on 17 Nov 2016 #permalink

Dangerous Bacon has a point there.

By Andrew J Dodds (not verified) on 17 Nov 2016 #permalink

I can see how being addressed by someone with a calming, charismatic manner - and I think people who do well in these roles have to have that - would be nice when you come into an ER stressed out of your wits. So I expect the presence of that person is not without value. But why add sticking needles in people if whatvyiure looking for is a calming influence?

By Dorit Reiss (not verified) on 17 Nov 2016 #permalink

"Yin qualities are night-like: cool, dark, restful, and passive."

Death is yin.

Anonymous Pseudonym #7

So, somewhat like a stilleto dagger, then?

re bloodletting

Although the standard acupuncture needles seemed painless ( I tried this woo because someone else paid for it)
the accompanying cupping treatment led to a form of bloodletting UNDER the skin which resulted in bruises that hurt and lasted for quite a while.
So much for free woo.

By Denice Walter (not verified) on 17 Nov 2016 #permalink

I didn’t even get to cancel my subscription–they cut me off (at least I never received another installment).

The same thing happened with my alumni magazine when I taped two nickels to the donation form and demanded to be listed as "The Colonel" as a donor.

So much for free woo.

It was worth exactly as much as you paid for it.

By Eric Lund (not verified) on 17 Nov 2016 #permalink

I was born in Abbott Hospital (before it became Abbott-Northwestern), and I'm shaking my head that Minneapolis of all places now boasts [irony] the first staff needler in a US ER. I can see how the ritual might help someone like John Pacharis get by with fewer painkillers – such folks go into it with a hope it will work, and the macguffin of the ritual allows their subconscious to do some mind tricks that alter their perceptions. I can't imagine that working in an ER, especially since patients roll in who wouldn't be predisposed to the mind game. I guess ERs deal with a range of things, from acute emergencies where patients are rushed in by ambulance, to minor injuries where patients drive themselves in and sit around for a long time before being seen. I wonder what range of patient issues they use it for, and how the apparent 'effect' varies among them. I don't have the energy to check the link for the study from Abbott.

Thinking back on the times I was ambulanced to to hospital, I was scared sh!tless...or maybe 'in panic' is a more accurate descriptor. My first thought on reflection was that getting acu-needled would have just made that worse. But then I had a second thought: I didn't mind getting big nasty IV needles shoved into my arm since I was already hurting, and I thought 'OK, they're doing something. Feeling the fluid go into my veins was hind of reassuring. So maybe sticking needles in people IS a calming experience. Maybe their reactions are near-reflex functions of the mid-brain, and the fore-brain cognitive processes that would lead to thinking 'this is bunk WTF?' just never get started. But there's simply no way I can imagine 'acupuncture' as the best way to achieve that sort of calming. I mean, couldn't whatever patient time Abbott is purchasing with Reinstein's salary be better spent on someone doing something that actually addresses the injury?
_____________

I'll joke (only a bit) in saying Orac could have ended the OP at the point where the acupuncture article was identified as appearing in EXPERIENCE L!FE Magazine. Not that I'm famiilar with that specific publication, but I've certainly seen the genre. Gushy, quasi-promotional pieces on 'health/wellness' magical thinking is their stock in trade, and make up maybe half (?) their editorial content. Thus, knowing the genre, I could have guessed pretty much everything Yeager wrote w/o actually reading it. And I could have auto-completed Orac's critique, too.

This being all so well-worn familiar, I find myself wishing the discussion went beyond the fact Yeager's piece is pseudo-science BS, and looked at the role these magazines play in the culture, economics and social relations of woo. I wonder if these rags might be the most important means by which woo is spread and supported in the US.

It just doesn’t seem like the article was written to convince anyone that acupuncture is worthwhile but to justify the already held belief that acupuncture is great.

I don't think so. For one thing, the two aren't mutually exclusive. You may think the level of hype would be say counter-productive to persuading the uninitiated, that it would set off 'sales pitch! con job!' warning sensors and activate skepticism. But message reception and processing is context dependent. If you pulled the article from the magazine, gave it to a randomly picked member of the magazines target demographic, and asked them to read it, they might well be put into caution by the approach. But the actual readers, even those who are encountering one of the CAM related pieces for the first, already have pump of acceptance primed in all sorts of ways. I'll spare the bandwidth of unpacking at length, and just note that everything in these magazines is presented in the same style – even the legit stuff is offered as magic and with magical promises, and these are all part and parcel of certain upper-middle-class 'lifestyle' aspirations represented by the attractive, 'fit', 'active' and happy people depicted on the covers.

Anyway, reading the OP sparked all sorts of question in my mind about 'the bigger picture' in which Yeager's article and EXPERIENCE L!FE Magazine are embedded. Who publishes it, how it makes money, how the different kinds of articles relate to one another, and to the ads surrounding them, who reads it, why, under what conditions (i.e. they may just gloss over the pieces without paying close enough attention to get more than the general positive vibe about the topic), what other media sources do they follow (Dr. Oz?), what are their desires, dreams, fears, what, if anything do they related to the stuff ballyhooed in the magazine? Etc. Etc.

To relate that back to RI, I'll just go back to Pandadeath's thesis: Does EXPERIENCE L!FE Magazine have any real effect on the adoption of pseudo-medicine by any significant number of people? If so, how big an effect, for what kind of people, and how exactly does that work? And, finally, what can any of that suggest about effectively countering that persuasion for anyone who might be susceptible to it?

I can tell you that if I’m ever in a car wreck and land in an emergency room, if I see an acupuncturist offering to stick needles into me the reaction will not be a pleasant one

That was my thought about battlefield acupuncture.

By shay simmons (not verified) on 17 Nov 2016 #permalink

Or at the very least, those needles better have syringes full of morphine attached.

By shay simmons (not verified) on 17 Nov 2016 #permalink

Yin Wibble and yang Wabble may have some value in philosophy.

By herr doktor bimler (not verified) on 17 Nov 2016 #permalink

sadmar@20: as a lifelong connoisseur of the cheap tabloids of the grocery-store checkout I've often wondered how much impact these "wellness: magazines have. I mean, "Women's World" has been telling me about the miraculous properties of apple cider vinegar since at least 1993.

In my experience the magazines that make me feel worst about my body (and offer the least-safe methods for addressing your horrible looks) are the magazines with "health" or "wellness" in the title. Running magazines intended for men and women are usually OK (though full of ads for that silly tape), but running magazines for women might as well be called "eating disorders and body dismorphia R Us!"

As for "natural health" magazines, I usually avoid them but this week was asked to do some research on nano-silver for my in-laws. They sent me an article that was so hilariously wrong I thought of Your Friday Dose of Woo. If you have any logical reasoning you wouldn't be caught, but if you read it credulously then there's a lot of happy shiny snake oil.

By JustaTech (not verified) on 17 Nov 2016 #permalink

if you read it credulously then there’s a lot of happy shiny snake oil.

We shall ride eternal, shiny and chrome colloidal silvered!

By herr doktor bimler (not verified) on 17 Nov 2016 #permalink

Maybe the people of Kentucky can build an Acupuncture Museum next to their Creation Museum. Or, to save money, just add a diorama showing a a man performing acupuncture on a triceratops.

I was told by my acupuncturist that what acupuncture does is creates small injuries to the body which increases blood flow-circulation to the area. Physical therapists now do an acupuncture technique and call it dry needling. And the needling produces opioid and other response in the brain on brain scans. At the end of the day dismissing it as quackery without further study is obtuse.