A new nomenclature for auricular acupuncture: The ultimate in Tooth Fairy science

Acupuncture is nothing more than a theatrical placebo.

I wish I could take credit for the term "theatrical placebo" to describe acupuncture, just as I wish I could take credit for coining the term "quackademic medicine" to describe the unfortunately increasing infiltration of quackery into academic medical centers and medical schools and as I wish I could take credit for the term "Tooth Fairy science" to describe doing scientific studies on a phenomenon that has not been proven to exist, but alas I cannot. I can, however, use the terms as I see fit, even if it might annoy some believers in acupuncture and other alternative medicine modalities that have no definable, demonstrable effect on any disease or medical condition detectable in randomized controlled clinical trials.

I can take credit, however, for pointing out that the history of "traditional Chinese medicine" was retconned by Chairman Mao Zedong. (I don't think anyone thought to borrow a term from comics and TV to describe the rewriting of history that Mao did to portray TCM as somehow being a single unified ancient and powerful system of medicine, so that he could sell it to his people (and later the world) as a viable alternative to "Western" medicine that should in fact be "integrated" into it. It's a process that's still going on today. Indeed, as I like to say, Chairman Mao was the father of "integrative medicine," at least with respect to "integrating" TCM into science-based medicine despite the lack of evidence that much, if any, of it worked, except for the occasional lucky guess.

However, as ridiculous as acupuncture can be, with its basis in ideas rooted in prescientific vitalism that claim that sticking needles into anatomically nonexistent "meridians" can somehow redirect the flow of "life energy" (qi) to heal, there is a form of acupuncture that is even more ridiculous than that, and it's auricular acupuncture. Basically, the idea behind auricular acupuncture is that there is a homunculus of the human body on the external ear, usually with the head near the earlobe and the feet near the triangular fossa (the upper part of the ear). Basically, in auricular acupuncture, an acupuncturist sticks smaller, shorter needles into the external ear, the location determined according to the homunculus to target the organ or body part that is diseased or in pain. This mapping generally corresponds to similar maps developed for that other form of homunculus-based quackery, reflexology. These are a couple of excellent examples of Tooth Fairy science, in which one studies the amount of money the Tooth Fairy leaves per tooth or the phases of the moon when she is most likely to come but never bothered to show that the Tooth Fairy exists in the first place. In this case, it is the existence of a homunculus mapping different organs to areas on the external ear that has never been demonstrated.

Sadly, auricular acupuncture is the preferred form of acupuncture that's been adapted to "battlefield acupuncture" (I kid you not), where our military (yes, our military) is training medics and other healthcare providers in its ranks to use auricular acupuncture right on the battlefield. Meanwhile, military hospitals and the VA medical system are rapidly adopting the same quackery.

Here's an example of such a homunculus (click to embiggen):

Of course, alternative medicine being alternative medicine and quacks being quacks, there is no evidence for the above homunculus, and other maps have appeared, some quite complex, like this one:

So naturally, given the rapidly expanding complexity of their quackery, the quacks practicing auricular acupuncture need a new homunculus. They need a new system that can incorporate the rapidly expanding list of areas to map to the ear. Not surprisingly, there are quackademic medical "researchers" who are more than willing to provide just such a system. Behold, published online ahead of print in that repository of quackademic medicine, The Journal of Alternative and Complementary Medicine, a "study" that provides just what cutting edge auricular acupuncture researchers need, a New Universal Nomenclature of Auriculotherapy. (No, I didn't capitalize that. The authors did. Humble, aren't they?) The authors, David Alimi, MD, and Jacques E. Chelly, MD, PhD, MBA, are both based at the University of Pittsburgh, in the Departments of Anesthesia (Alimi and Chelly) and Orthopedics (Chelly). I do find it appropriate that Dr. Chelly has an MBA, because, of course, the business possibilities for auricular acupuncture are endless.

So what is the justification for needing a new system of nomenclature for auricular acupuncture? I'll let Alimi and Chelly explain:

Auricular acupuncture (Auriculotherapy) has gone through the centuries, and, in particular, the last 40 years, going from traditional to modern. By word of mouth, from empirical practice to efficient medicine, it was slowly approved, thanks to neuroimaging progress, and has become, at least, a part of neuroscience.

Since the rediscovery of Auriculotherapy by Paul Nogier in 1957 in Lyon (France), and his brilliant vision of a fetus curled up in the ear pavilion, presaging the understanding of his somatotopic bases, modern neuroscientific knowledge has allowed us, as neurophysiologists, to bring understanding of the neurophysiological bases of its action.

Since this scientific certification, its development, universal propagation, and academic education have never stopped developing, just like the multiplication of clinical and experimental study publications.

After Dr. Paul Nogier's initial cartography of the ear, multiple cartographies have been developed by different authors/countries/schools. Until recently, the construct of these cartographies was anatomically based. Basically, the ear was divided in anatomic zones (helix, Antihelix, Tragus, Lobule, etc.) and each zone was subdivided in areas. This led to the description of each point by a letter referring to the zone and a number referring to an area within the zone.

The World Health Organization (WHO) recognized it in 1987 and developed its first International Nomenclature in 1990 (Fig. 1). Its continuous development currently requires an update of its international standardization.

The WHO? Et tu, WHO? Sadly, it's true. The WHO did come up with a nomenclature for auricular acupuncture, which was published in 1991. It's a simultaneously depressing and hilarious read, pure pseudoscience, a blot on the WHO forever. Fortunately, I haven't been able to find anything on the WHO website like it that's more recent, other than a couple of papers that have references about auriculotherapy or auricular acupuncture in them.

But what about Paul Nogier? Who is he? Or, rather, who was he, given that he died over 20 years ago? Well, helpfully, there is a website that tells all about him and how he "discovered" auricular acupuncture. I got a bad feeling about Nogier from the very first paragraph:

The XIXth and the XXth centuries were the centuries where the chemistry was omnipotent and where the medical therapy was based upon this chemistry. For every disease, a chemical drug. For every symptom, a molecule. It was very rare in the XXth century that someone explored new physical paths for therapy. Dr. Paul NOGIER, who received a formation as an engineer, looked at the individual with an eye of a physicist. He understood that the biological systems were not only sensitive to active chemical substances but also to physical stimulations. Therefore he systematically tried to find physical therapies to be used in the treatment in order to avoid the secondary effects of the chemical drugs. As soon as he graduated in medicine in Lyon, he focused his interest on homeopathy, as the homeopathic granule liberated from any chemical substance, finds its action through the physical electromagnetic information. Afterwards, he studied manual medicine and later acupuncture.

Yep. Even though he was a physician, Nogier was a practitioner of The One Quackery To Rule Them All, homeopathy. He was also into other forms of woo, like "energy medicine." Indeed, he claimed to have discovered "through painstaking research with the subtle energies of the body" three frequencies that "stimulate the creation of our body tissues." His "finding" with respect to this was described by Dr. Charles McGee, who attended one of Nogier's lectures in 1975:

He must have been astounded by the orderliness of a pattern he discovered. He found that specific body tissues were in resonance with specific frequencies according to their embryologic origin. … I believe this single finding will one day be recognized as one of the greatest discoveries of medicine, possibly worth a Nobel Prize for Nogier.

Vibrations. It's always the vibrations with quacks. I know I've said that before. Maybe I should say: Le vibration. C'est toujours le vibration. Oddly enough, poor Dr. Nogier died without ever being awarded a Nobel Prize.

Vibrations or not, this next part will sound very familiar to those of you familiar with the history of chiropractic and how D.D. Palmer "discovered" chiropractic:

In 1951, Paul NOGIER received in his consultation a patient, who explained to him that he was relieved from a sciatica pain by a cauterisation on the ear carried out by a quack in Marseille, Madame BARRIN. Following this observation, Paul NOGIER examined the external ear and tried to understand why this strange cure took place. It will take him more than 30 years to ascertain the mechanisms of the ear properties.

Yep. A patient with a "miracle cure," although this miracle cure isn't as impressive as what Palmer claimed, the cure of someone almost deaf by a "pop" in his spine. Poor auricular acupuncture. It can't even come up with an impressive origin story, either. However, just like every good quack who invented a medical treatment (or, in this case, almost a system of medicine) out of whole cloth, Nogier has been portrayed as laboring many years to figure out that there supposedly exist points in the ear like acupuncture that appear as soon as "pain or functional disorder is provoked" in the body. Supposedly, these points can be detected either by pain sensitivity or with equipment designed to detect electrical impulses in the skin. According to Alimi and Chelly, it is known (obligatory Game of Thrones reference) that the surface of the external ear carries areas of lower resistance that appear in the case of the presence of a functional disorder. It is (also) known that "every point on the ear corresponds to a well defined part of the body" and that a "real cartography is present on the ear."

Using that idea as a jumping off point, man, oh, man can the adherents of auricular acupuncture do up some sciencey quackademic medicine studies to justify their woo! In this case, Alimi and Chelly reported on how they used electronic database searches from 1958 to 2012 to find different formulations of Auricular Acupuncture Points (AAPs). They then claim to have studied brain dissections and to have "proved the neurophysiological correlations existing between auricular displays and their brain correspondences." Hilariously, they claim to have found that the middle of the corpus callosum (the structure that connects the two hemispheres of the brain) is the "epicenter of the somatotopic organization of the brain homunculus." Funny, but that's news to neuroscientists, I'm sure! In any case, the authors used this risibly unbelievable analysis to propose a new way to divide up the ear for purposes of auricular acupuncture. It involves a semicircle of an angular value of 180°, which they divided into 20 equal angles (that is, 9°. The called this the “Segmentogram,” which covers the totality of the surface of the auricle. Overall, this system divides the lateral ear in 189 areas and the medial ear in 89 areas. It's easier just to look at the illustrations (click to embiggen):

And these areas of the ear supposedly map to organs and body parts (click to embiggen):

It's really complicated; so it must be right, right?

Wrong.

There are no neuroanatomic correlates to suggest that there is any sort of mapping between body parts and organs to specific areas on the external ear. This is the ultimate in Tooth Fairy Science, which is basically doing studies on a phenomenon that has not yet been shown to exist. Sadly, there's a lot more where that came from in quackademic medicine.

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The shamelessness of the fraudulence is somehow impressive.

By herr doktor bimler (not verified) on 24 Aug 2017 #permalink

I just thought of a test one could perform for this.
Point 5 is (supposedly) attached to the eyes, and is also the area where most ear piercings occur.
So, we take a group of people who are about to get their ears pierced. Given how many people who have their ears pierced, there would be thousands. Then we test their eyesight before the piercings. Then we wait a few weeks after the piercings and test their eyesight again.
I know this is ridiculous, but I couldn't resist.

By Julian Frost (not verified) on 24 Aug 2017 #permalink

"Ear Acupuncutre"? Dear Lord, what wingnuttery is this?

By Rebecca Fisher (not verified) on 24 Aug 2017 #permalink

A Question!

Do these points decuss at the pyramids, like other sensorimotor pathways? Or are they ipsilateral, like spinal reflexes?

These people claim to be neurophysiologists, after all, so they should know.

fusilier
James 2:24

Rebecca@2: It's second-order woo, combining the nuttiness of acupuncture with the nuttiness of reflexology.

He found that specific body tissues were in resonance with specific frequencies according to their embryologic origin.

Putting the lie to any claims that M. Nogier was looking at the problem like a physicist. As every physicist (and for that matter every musician) knows, resonant frequencies decrease as the size of the object increases. There are other factors involved as well, but anybody who claims that a specific tissue will always have a specific frequency is selling you garden fertilizer by the truckload.

By Eric Lund (not verified) on 25 Aug 2017 #permalink

Containing the words aurum and cul, Auriculotherapy seems to be a way to gild one's ass,

So I lost a hunk of nose to skin cancer. Before the Mohs surgery I was presented with three possibilities--a nose with a patch, a smaller nose with thin, stretched skin, and what one might call a Micheal Jackson nose--small children won't scream at you but that's about it.

Now I ended up with a smaller nose, but there was a great deal of anxiety and reading of surgical journals. (There was much ecstasy and song when the doctors told me I was group two.) In the third case, they remove all that curly stuff in your ears, leaving you with what looks like two funny shaped soup bowls and a strong desire to wear your hair long. The little bits of cartilage are stitched into sort of a tent, but it's too small and wobbly and never the perfect shape. As said though, small children will not scream and run.

I'm just wondering what this would do to my aural fetus, and what dire and drastic symptoms others who are not so lucky have experienced. Why don't they study those?

By Christine Rose (not verified) on 25 Aug 2017 #permalink

It’s second-order woo, combining the nuttiness of acupuncture with the nuttiness of reflexology.

I realise that, but they can't even spell it!

By Rebecca Fisher (not verified) on 25 Aug 2017 #permalink

I now understand why ranchers ear notch their cattle. It keeps the cows from having bad ankles. Any takers on the bet that I am being sarcastic?

My favorite "explanation" offered by auricular acupunturists is that the ear "is the only organ with all 3 tissue types". As if that were adequate to account for all their claims. In their world, embryonic origins of tissues confers life long connectivity of those tissues with or without any demonstrable connection.

Apparently you can make this stuff up.

Dr. Paul NOGIER, who received a formation as an engineer, looked at the individual with an eye of a physicist.

Thus giving a bad name to out-of-field physical scientists the world over.

He found that specific body tissues were in resonance with specific frequencies according to their embryologic origin.

A physicist wonders why these studies don't include any spectroscopy. A simple question to ask is "What frequency is that?" This screams "graph!" or at the very least "table!"... frequency versus embryonic line. No Nobel awarded without real quantitation. I regret that I looked into that review for some evidence of spectroscopy and found none.

So, when I'm scrubbing my ears in the shower, is that beneficial or negative for my body? What about those annoying ear itches?

Christine, sorry about your cancer. What a choice! I hope that your great sense of humour helped you through it.

Which reminds me, wasn't cutting off ears a punishment in the past? Why didn't the victims just up and die after losing their aural fetus? Rather than wishing they were?

By Jane Ostentatious (not verified) on 25 Aug 2017 #permalink

So what happens if you're one of those people who don't have earlobes?

Where is the spot that maps to pain in the outer ear?

By j a higginbotham (not verified) on 25 Aug 2017 #permalink

What part of the body does ear hair correspond to?

By Old Rockin' Dave (not verified) on 25 Aug 2017 #permalink

There are things this makes me wonder about.
If you burn your ear during ear candling, do you need to be admitted to a burn center?
Did all the people who ever told me "Stick it in your ear" actually care about my health?
Will Gwyneth Paltrow start recommending cervical acupuncture?
If parts of the ear correspond to the genitals, can you have aural sex? And is this what "stick it in your ear" really means?

By Old Rockin' Dave (not verified) on 25 Aug 2017 #permalink

What about boxers with cauliflower ears? How do you approach all that extra tissue? Or people with super gauged holes in their earlobes?

By JustaTech (not verified) on 25 Aug 2017 #permalink

It's the equivalent of Terry Pratchett's Reverse Phrenology. Decide what state of physical health you seek, and stretch your ears correspondingly.

By herr doktor bimler (not verified) on 25 Aug 2017 #permalink

Just asking for a friend - a sort of follow up to ORD at #16 - can you tonify a certain area (male) instead of using the too expensive & risky Viagra?

By Peter (Oz) Jones (not verified) on 25 Aug 2017 #permalink

Speaking of stretched ears, I remember "older" women who wore heavy earrings having stretched, extra long earlobes. How does that affect this accupuncture system?

Oh, the unanswered questions!

By Jane Ostentatious (not verified) on 25 Aug 2017 #permalink

So, if all body parts are represented on the ear homunculus, then the homunculus ear itself should also be represented on the real ear, right? But does that create a map within a map? Like, is there a never-ending series of tiny ear homunculi within tiny ear homunculi? My goodness, where does it end?!
Or, if the homunculus somehow does not have an ear, then how can I possibly cure my outer ear ailments? There would be no way to access my ear using this totally amazing and revolutionary miracle cure! I'll just have my quiet existential crisis over here.

By Charlotte N. (not verified) on 26 Aug 2017 #permalink

It's turtles homunculi all the way down!

By Se Habla Espol (not verified) on 26 Aug 2017 #permalink

Ah, so the traditional punishment of a slap along the ear in fact constitutes a very efficient whole-body treatment?

Well, the cop who got his ear cut off in Reservoir Dogs expired soon after. So maybe there's something to this after all.

cheers,
Dr. Blonde

Speaking of movies, I'm reminded of the Woody Allen character's response to Diane Keaton's ex (and purported demon lover) in Manhattan -. "But he's a a a.... homoculus!"

By Jane Ostentatious (not verified) on 27 Aug 2017 #permalink

I have medium-large gauge lobes, and an assortment of other smaller metallic piercings, and yes - I have had hippie/woo practitioners tell me in all seriousness, uninvited and unprovoked, that I have 'ruined' my ears and potentially my health. One stopped me in a shop to tell me so.

So one wonders what happens when the foot section of the ear is needled at the same time that the reflexologist stimulates the ear area of the foot. Self-immolation? The body being sucked into its own black hole? Or just laughing from the tickles?

By Doris Walker (not verified) on 28 Aug 2017 #permalink

Feedback loop and DIVIDE BY 0.

By herr doktor bimler (not verified) on 29 Aug 2017 #permalink

MsV - I don't really care for gauges or multiple piercings in my heart of hearts, (but I had my nose pierced in the 70's, but took it out when was looking for real work in the 80's. Oh, and lots of ear piercing) but I hope that you live forever in excellent health and all happiness just to spite those self righteous dingbats.

By Jane Ostentious (not verified) on 29 Aug 2017 #permalink

I am saddened at your post and would love to speak with you. Where are you located Sir?

Do you see the words written in blue letters, Raeann? Those are links to other websites. Do you think there is a reason the author's name is in blue letters?

Perhaps you should tell everyone here why you are sad about this post. Perhaps provide actual verifiable scientific evidence to prove the author wrong.

Or do you just want to yell obscenities at him?

Wow! Chris it’s amazing you wanted to assume I wished to yell anything. Breathe deep, in through your nose and out through your mouth, you obviously need to relax a bit.

Yahoo, more condescending new age twits.

By Politicalguineapig (not verified) on 25 Oct 2017 #permalink

Raeann,

I think there are a couple of reasons people are confused here. First of all, Orac's bio is available by clicking on the blue link ("by Orac") at the top of the article. He is in a hospital in Detroit.

Second, why do you wish to find him in person? It would be inappropriate for you to head out to his workplace and get arrested. (If there's any place you don't want to mess with, it's a hospital in Detroit.) That's why you were asked about yelling. If you actually want to dialogue with him, you shouldn't be asking for his physical location.

Finally, you are unlikely to convince him that ear acupuncture is a thing unless you understand why he is convinced that it is not a thing. You ought not assume that you know more about it than he does.

By Christine Rose (not verified) on 25 Oct 2017 #permalink

Raeann, Orac's identity is one of the internet's worst kept secret. If you had done due diligence you would have looked at other articles he has written on his blog.

In fact, much of the information you asked about have been linked to in his most recent posts because this site is moving. It has links to his new blog, where he wrote about his history online.

By the way, Orac has been stalked. One particular young man attended a talk he was given only to rant at him about something he disagreed with. So, yeah, there is precedent.

If you wish to civilly state your disagreement with the article, then you would post the PubMed indexed papers that support your position. If those do not exist, then you should design a study, get it approved by an Independent Review Board for compliance with the Belmont Report, gather some funding, do the study, write it up and then submit it for publication in a reputable medical journal. Because neither Orac nor us minions are going to take just your word that something works.

Why can't chiropractors stick to the one thing that they might actually be qualified to do, relieving lower back pain? Why do they always have to pile on other non-scientific nonsense services like reiki, acupuncture, cranial-sacral whatever, homeopathy, supplements, etc.?

I know the answer: to boost the revenue stream from customers who are already vulnerable to nonsense and predisposed to believing in magic. Their customers are "pre-qualified," to use a sales term.

By Woo Fighter (not verified) on 25 Oct 2017 #permalink

Could it be Raeann makes money selling this procedure to customers?

That would be hilarious:

"TRT is a non-linear, non-mechanistic, neurological method of testing and adjusting. A low-force high velocity instrument called the Integrator is used to remove subluxations that cause nerve interference and restore the body’s function at its highest potential."

Torsion. You keep using that word.

Oh, and she believes in subluxations too!

By Woo Fighter (not verified) on 25 Oct 2017 #permalink

I actually did acupuncture for a couple of years, courtesy of my Mom, who is normally a smart woman. They did my ear one time: they had to pull the needle out immediately, because it hurt.

By Politicalguineapig (not verified) on 25 Oct 2017 #permalink

Woo Fighter: well, they chased off this former customer. I do think a chiropractor did help my neck pain after I got rear ended.

Then I moved, and my new chiropractor was heavily into woo. I didn't believe for a minute that adjusting my back would have any impact on my GI system, but when he started talking about spinal adjustments on newborns, I was done.

Then I started reading more about chiropracty and the risks involved in adjusting the neck.

Never. Again.

Panacea,

I'm glad you saw the light before you were either a) injured or b) drained of any more money.

I was really referring to the alt crowd that avoid "allopathic" (sic) doctors in favour of chiropractors, who typically appeal to the anti-vaccine, natural, "wholistic" audience. Once you believe in one thing they sell, it's easy to sell you other magical services. "Since chiropractic seems to have re-energized the vital forces in your torso, thus clearing up your asthma, we do offer this follow-up treatment called " ... (whatever)" that can polish your chakras and bring your entire being into focus.You wouldn't want to start the job of total harmonic alignment and not finish it, would you?"

By Woo Fighter (not verified) on 25 Oct 2017 #permalink

Oh, and she believes in subluxations too!

It's not entirely clear to me how a device styled as "The Integrator" is supposed to remove something, but whatever.

It effectively removes cash from wallets.

By Woo Fighter (not verified) on 25 Oct 2017 #permalink

In response to Peter (Oz) Jone #19 there is a opening picture in Dr. Paul Nogier's Treatise on Auricular Therapy of Hieronymus Bosch painting Garden of Earthly Delights with an ear where a demon spear ponts to a point on the anterior helix now know as the Bosch point. This is point is used in auriculotherapy for it "viagra like effects." However the tail of the spear point to the another named after Saint Jerome and has an anti-aphrodisiacs effect. The large arrow goes through a major point Shen men or "Spirit's Door" and there is a knife/phallus projection from these two ears. This most famous painting is over five centuries old.

By Howard Wu (not verified) on 26 Oct 2017 #permalink

Having read most of Dr. Paul Nogier's writings I can't recall seeing any references to skeptics favorite straw dog homeopathy. Plenty of references to the various cranial nerves running to the different surfaces of the ear: a parasympathetic branch going to the concha, trigeminal going to the earlobe for example. Also discussion of thalamic nerve tracts for pain sensations. He describes a second class of points that anatomically correlate to neurovacular bundles including dendritic cells (cells of Langerheim.) His use of "frequencies" come from a study of these new points that show a response in the sympathetic vagal tone. Charts of these frequencies are available however very few auriculotherapists know how to use them.

By Howard Wu (not verified) on 26 Oct 2017 #permalink

Parasympathic branch of the vagus, named a century ago as Arnold's vagus branch. Also see Aroold's reflex.

By Howard Wu (not verified) on 26 Oct 2017 #permalink

But doesn't the fact that the various nerves to the ear come from various directions contradict the whole idea? There's no direct nerve to the genitals for example (no acupuncture Viagra). At that level, all the nerves at all the body parts can be traced to another body part.

If the claim were that you can do experimental vagus nerve stimulation (to treat seizures) with a device in the ear, well that's actually happening. The claim that poking a spot that seems to be the homunculus gall bladder will treat gallstones, not so convincing.

By Christine Rose (not verified) on 26 Oct 2017 #permalink

Christine Rose: while the thought of acupuncture is bad enough, Viagra acupuncture is more than cringe worthy. The pain, oh the pain.

^ Wrong thread, sorry.

Narad,

Thanks for the ping :)

Alain