Is the Science of Acupuncture Wrong? Evidence Mounts from Clinical Trials

I believe that acupuncture works to a certain degree on some pain. I don't believe the ancient Chinese science on the subject. I don't believe that chi circulates through meridians -- in fact, since chi has never been proven to really exist in an actual clinical trial, I am extremely skeptical about its existence. From an internal arts perspective, I believe that all skills are physical, the result of hard work and practice, not "chi cultivation."

One problem I've always had with articles and books about acupuncture is the sloppy science and anecdotal evidence used to back up theories and results. Most articles in magazines or stories on TV are done either by reporters who don't question the results, or by people who have a financial interest in making acupuncture look effective. What we've needed are double blind clinical trials that eliminate the rigging of the results.

Recent clinical trials -- conducted by people with no financial stake in the outcome of the trials -- suggest that acupuncture has some beneficial impact on pain relief. They also suggest that the science of acupuncture is wrong.

When the clinical trial included both traditional acupuncture plus FAKE acupuncture, there was virtually no difference in the amount of pain relief experienced by different groups of patients. Whether you were given real acupuncture, with needles inserted into acupuncture points, or whether you were given fake acupuncture with needles inserted into random points or toothpicks poking the skin -- both groups experienced a certain amount of relief.

For years, I've read people who fervently believe in acupuncture claim that there is a bias among Western scientists and doctors against acupuncture. Quite the contrary, there is no bias, and several clinical trials have now been conducted to test acupuncture's effectiveness. The results are typically the same -- some pain relief -- but the tests don't show enough improvement among enough patients to attribute it to more than the placebo effect, possibly the result of a patient expecting improvement.

One of the most recent trials was conducted using traditional acupuncture on one group of patients, while another group was poked with a toothpick on acupuncture points. Read a Reuters report: http://tinyurl.com/acupuncturetrial

Here is an important conclusion from this trial:

Conclusions  Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.

One of the most interesting clinical trials was done at the University of Liverpool. One group of patients suffering from pain was given traditional acupuncture. Another group had acupuncture needles inserted into random spots on their bodies. Neither group knew whether they were getting real or fake acupuncture. Both groups experienced the same amount of pain relief. Here is the article: http://research-archive.liv.ac.uk/455/  NOTE -- A reader noticed that I had misread this study. In fact, he was right. There had been an earlier clinical trial at the University of Liverpool that showed no difference in results. This trial, however, shows some difference, with acupuncture on the winning side.

I'm trying to find the earlier study. In looking for it, I uncovered another clinical trial that investigated the effectiveness of acupuncture on fibromyalgia with no difference between those that received acupuncture and those that received sham acupuncture: http://www.annals.org/cgi/content/abstract/143/1/10

There is another roundup of acupuncture trials. Researchers examined results from clinical trials to see if they could determine if acupuncture was a valid treatment. They determined that it is not: http://www.bmj.com/cgi/content/full/338/jan27_2/a3115

These studies are very important because they offer clear proof -- as close to clear proof as you can get -- that the human body responds to the insertion of needles or the prodding of toothpicks in a beneficial way that helps reduce pain to a certain degree. However, the most important point in these studies is this -- acupuncture science is very likely wrong. You obviously don't have to insert a needle in a specific spot to get the desired effect. That's why some scientists have suggested that rather than "chi," acupuncture (or fake acupuncture) triggers the release of endorphins that ease pain. Another very possible interpretation -- people expect positive results from the treatment, so they experience the placebo effect.

One interesting theory is that many centuries ago, the Chinese realized that the insertion of needles produced a beneficial response by the body. As a result, they developed complex theories of points and meridians, and rules of where the needles needed to be placed, how many needles, and even the best time of day to do it.

None of that seems to matter.

There have been several clinical trials of acupuncture. Some of the results can be found here: http://www.bmj.com/cgi/content/abstract/338/jan27_2/a3115

I've studied martial arts for nearly 36 years and the internal arts and chi kung since 1987. I studied acupuncture for two years. For a while I embraced the reality of chi, until I began to see that a lot of things didn't add up, and a lot of fakery was going on. Once you begin to question and explore, it unravels and you see the man pretending to be the wizard behind the curtain.

During this time, I've also noticed that belief in chi is very similar to religious belief -- those who believe won't change their opinion no matter what type of evidence is presented to them to the contrary. But for people who prefer a more independent and objective approach, these studies provide a gold mine of research.

Comments

[Dale]

While I agree with you overall, the Liverpool study shows that the real acupuncture had a much greater efficacy than the sham acupuncture. You said "Both groups experienced the same amount of pain relief" which isn't the case from reading the study.

That said, even in my limited martial arts study I have found nothing to show evidence of chi. I've seen amazing things that the body can do, and even knocking someone down without touching them, but it's all explainable without the "mystical chi powers" or "empty force!"

[Gary Liu]

Hi Ken. Very interesting post. I agree with you.

I deeply believe in Chinese herbal medicine, being a frequent user of it. And it was able to heal a skin condition of mine which Western medicine had no idea. (It has to do with "damp heat".)

I have also had acupuncture for shoulder muscle tightness, which frankly I thought was largely a waste of time as I felt no different afterwards.

With your view on chi, Ken, what then is the purpose of doing chi gung like the 8 Brocades? I am interested to know. I am wondering whether it is really possible to increase a person's "vitality" or life force doing chi gung. Or will any exercise do.

Sincerely, Gary

[jim criscimagna]

Thanks for the links on the various research. Interesting ... the "qi model" as used by the Chinese is really foreign to me. What cracks me up are westerners who buy the whole thing hook line and sinker and think that if you don't, or have some reservations, you are not really going to get anywhere in the internal arts. Now that is just silly.

Someone I know asked CXW about if it was necessary to believe in qi in order to get good at Taiji (or if he believed would they have an advantage). He said, "NO", much to the surprise of the person that asked the question. CXW went on to say if they practice correctly, believing in qi is not necessary to reach high levels.

I stand somewhere in the middle of this debate ... don't believe or disbelieve, just don't give it much thought, only practice what I have been taught and am very satisfied with that.

The new aged types that want to invest in studying qi, go for it. Not my interest.

So there you go. ;^)

[Matt "Ikigai"]

Great gathering of information and a very well written analysis of this concept. Chi, and those people dependent on its existence as some sort of force, can be very resistant to science and evidence.

[Ken]

You know, I wasn't notified that I had replies to this until today. Dale's reply actually uncovers a mistake that I made. In fact, the particular Liverpool study cited in the original post did show a difference in the group that experienced real acupuncture and they felt it was statistically significant. I thought this was a different study and I've been searching for it. Meanwhile, I found another study from the University of Liverpool, too, and it found improvements in symptoms in the group that experienced real acupuncture from those who got the sham treatment. Here's a link to that study: http://pediatrics.aappublications.org/cgi/content/full/114/5/1242

I'll continue looking for the other study I had read some time ago.

As I said, I believe the human body responds to needles but not the way ancient theory suggests. So I'm never surprised when people treated with acupuncture feel better. Notice in the link above, some people receiving the sham acupuncture dropped out of the study because they didn't feel it was effective. Obviously, more investigation is needed before completely buying into the acupuncture model.

[Ken]

Hi everyone, I updated the original post with new information and links. Although there are occasional trials that show more improvement in the acupuncture group, most trials show no difference, and a roundup of clinical trials that was examined by researchers also showed no evidence that acupuncture works better than sham treatment. It's possible that the occasional positive study is positive due to other factors (luck, ability of acupuncture group to have higher expectations, or a variety of other factors). Although I'm not happy with myself for putting the wrong link up on the Liverpool study, I don't mind showing that acupuncture does sometimes have effectiveness because I believe it does, based on the body's reaction to needles, not on TCM theory.

[Robert Reppert]

Good article and conclusions Ken.

[Mark]

I found this article interesting. As an acupuncturist, I obviously have some issues with it.

Have none of your students explained that they "feel" or "experience" feelings that transcend the normal "Western" interpretation? How do you answer to those?

I think that Western Science might eventually catch up, but in the mean time, it is important to focus on results. My patients have received much more benefit from acupuncture than simple pain relief (though that is certainly a beneficial outcome). If you don't believe me, take a look at some testimonials ( http://atlanta-acupuncture.net/test.html ) that show a wide range of benefits.

If it was as easy as sticking needles in the body without regard to location, then that would have been exposed long ago and issues such as infertility would not be quite as prevalent.

I also question "double-blind" studies where fake acupuncture is used. How does the acupuncturist become blind in such a case?

Please understand that I actually appreciate posts such as this and do not feel animosty at all. I think it is good to air these things out and hopefully, one day, we will have a more definitive answer.

Best Wishes,
Mark

[Ken]

Mark,
Testimonials -- anecdotes -- are the worst form of evidence, as you know. They have little value outside of a double-blind setting. And since you're an acupuncturist, with a financial interest in proving acupuncture is real, I would expect you to defend it. If someone is going to examine acupuncture for factual reality, the last person to believe is the one with a financial interest in it.

I believe you have helped some people, but I doubt that it is because of the intricate "science" developed so long ago but for other reasons.

If you know about double-blind studies, and you might not since you are not a medical doctor, you know that the acupuncturist wouldn't be "blind" in a double-blind study. The person receiving the acupuncture wouldn't know if it was real or not. The doctors who examine the patients later also don't know -- thus, "double blind." Because of this, the patients report their pain relief and the doctors can't apply any pre-conceived notions because they don't know which group got the real acupuncture.

When Richard Mooney was tested in a double-blind setting (he claims to knock people down without touching them) the people who were put before him didn't know what he was trying to do. The events were videotaped and a group of scientists watched the video and they also didn't know what he was trying to do, so they couldn't pre-judge and apply their opinions to the results that they saw. That is double blind.

Last November, as I was recovering from a near-death experience at the Cleveland Clinic, I went to a popular local acupuncturist -- who had been a neurologist in China. I was coughing up blood and -- since I do believe acupuncture helps some conditions, I wanted to give it a shot.

After the first treatment, I began coughing up blood twice a day, and it got worse after the second treatment. I halted the acupuncture treatments and a month later, I stopped coughing up blood.

Ironically, I didn't really start improving until I began seeing a chiropractor about 3 months ago.

So, as you can tell, my mind is FAR from closed on these therapies. But when you talk about science, and the evidence and proof behind acupuncture, it is very difficult to support because the theories and "facts" just don't hold up under scientific scrutiny.

[Mark Schwartz]

Ken
1. I understand you quite well that you are interested in seeing the "Science behind the magic" I see patients from all four IVF centers in Atlanta. However, I work most closely with reproductive encrinologists at one place in particular, Georgia Reproductive Specialists. 2 years ago the doctors there were in a different place about their opinions about acupuncture. A patient of mine asked then, at one of their IVF informational nights, "what do you think about acupuncture?". Back then Dr. Perloe, said something along the lines of "Maybe its helpful for relaxation". Over the last year I have "flooded" him with research to show him the validity of what I do and how it can help his patients improve their success rates with what he provides. He was sceptical at first. All doctors want to see research to support the efficacy of any medical treatment, this is there language...and I respect that. If you click this link to my site you can find a link at the very top to click to this doctors experience with receiving a treatment and what he told patients a few months back. http://atlanta-acupuncture.net/fert.html He and some of the doctors are further along now, referring patients regularly, some of which who are difficult cases that we work on in combination or sometimes he asks them to take a break and see me solo for sometime before returning to his practice. You cannot dismiss all other forms of research or discount the clinical success we have shared.

1. While double-blind studies are the gold standard, I wish you to continue with your open-mindedness and have a look at this article entitled, " Why We Should Change the Course of Acupuncture Research". I will attempt to email it to you, as I could not find an easy place to refer you to online.

2.I am a fellow of the American Board of Oriental Reproductive Medicine (ABORM.org). Please see the research at http://www.aborm.org/research/research.html The ABORM is a non-profit 501(C)6 corporation devoted to teaching, research, and the practice of Oriental Medicine as it relates to the treatment of reproductive disorders.

3. Please take a look at the research here http://www.eastwindsacupuncture.com/medical-articles conducted by a Reproductive Endocrinologist (M.D.) Dr. Magarelli and acupuncturist Diane K. Cridennda. For over six years they have conducted research and published articles in major journals such as Fertility & Sterility and textbook Infertility and Assisted Reproduction (cambridge press).
4. Hope you will take some time to consider the research sited in above sites and realize that this is only for one very narrow topic - infertility- and possibly concede to the point that there is more than the "occasional trials that show more improvement in the acupuncture group" out there to support the scientific efficacy of Chinese medicine effectively treating disease.

Respectfully submitted,
Mark Schwartz FABORM,
Dipl. O.M. (NCCAOM)

[Ken]

Mark,
I appreciate your attitude and I enjoy this discussion.

Remember however, I didn't say that acupuncture wasn't effective -- at least in some cases.

What I question is the science behind it -- the TCM theories about meridians, points, and the existence of "chi."

In looking at the first study on the list (Reduction of blood flow impedance in the uterine arteries of infertile women with electro-acupuncture), it appears there was a beneficial impact on the 8 women who were in the study at the end. It wasn't a double blind study, however, and the study itself said that more studies were needed before they could rule out other factors.

It also included this important paragraph: "The mechanisms of sympathetic inhibition following EA are poorly understood. Based on animal experiments, Hoffmann
and Thoren (1986) and Hoffman et al. (1987, 1990a,b) suggested that electrical slimulation of muscle efferents
innervating ergoreceptors increases the eoncentration of ß-endorphin in the CSF. They found support for the hypothesis
that the hypothalamic ß-endorphinergic system has inhibitory effects on the vasomotor centre, and thereby a central
inhibition of sympathetic activity. It has been suggested that this central mechanism, involving hypothalamic and brain
stem systems, is important in changing the descending control of many different organ systems, including the vasomotor
system (Andersson. 1993; Andersson and Lundeberg, 1995)."

The National Institute of Health has said that acupuncture does have some benefit in some cases (particularly pain management), but the Western belief centers around the stimulation of endorphins by the needles, not on "chi."

This is exactly what may have happened in this study, and if so, it would prove my point -- the complex science of meridians and chi stimulation are wrong, but acupuncture needles stimulate endorphins in the body.

I would have loved to see a control group of women who were given sham acupuncture to see if they experienced similar results.

Now, these are long studies and you sent me a bunch of them. If you can summarize some of them and be objective about it, I'd like to see if any of them go beyond this one. I'll read more of them as I have time and comment on them, but if they are like this one, they do nothing to support the science behind TCM.