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Treatment by acupunctureRecently, a paper published in PLOS ONE shed light on 30 acupuncture patients in China, who contracted, or were suspected of contracting  a cutaneous form of tuberculosis from the same clinic. This type of Mycobacterium tuberculosis can cause skin lesions and hard-to-heal abscesses, which take sinus tracts forming ring shaped lesions on the brain.  Fortunately, after close to a year of intensive treatment, all patients were cured of their primary inoculation tuberculosis.

But as the study made the rounds on evidence-based healing websites, a more important question was brought up, and that is about the risks associated with this CAM therapy, particularly that of sterilization in acupuncture clinics. Nowadays, most of the needles used are disposable, which is good-it prevents the possibility of blood-born infections from spreading through the use of needle sharing. But many clinics couple their acupuncture with electrotherapy and/or moxibustion, etc.  and that does introduce potential surfaces for bacteria to manifest. And there are many variations in styles of acupuncture, they’re not all created equal-though I would argue they’re all as effective as a placebo.

The thing about acupuncture is that it is based on an ancient and prescientific understanding of the world: one where illness is caused by demons, spirits, or in this case the blockage of qi (chi) through the body’s meridians, rather than germs. Modern day science has found no reason to believe there’s any such thing, and since practitioners cannot give a precise definition using quantifiable detection of or practical mechanism for which qi interacts with any other known forms of matter, the theory of life force pretty much falls flat. Of course these notions are central to acupuncture, acupressure and other vitalist movements, so speculative as they are, they continue to operate with no reasonable explanation. It’s just magic.

With that in mind, how well can you trust that the person you’re paying to help your arthritis pain has considered all matters of sanitization before beginning a procedure that could potentially introduce pathogens into broken skin? Does their idea of sanitization involve hand washing, nitrile gloves and germicidal wipe downs of their equipment? Or do they believe “smudging” the air with protective herbs is enough? Remember, there is no regulation of CAM clinics or health spas, and board certification of practitioners is frighteningly inadequate with regards to basic medical knowledge. Marc Crislip, a contributor toScience Based Medicine and infectious disease expert looked into what kind of biomedical training acupuncturists seeking recognition as Primary Care Providers received. He was not impressed. He also argues that based on the sheer number of serious complications that have come about at the hands of acupuncturists (including the ex-Korean President who was found to have a needle sunk into his lung), their knowledge of anatomy and depth at which needles may safely be placed is lacking.[1]

Acupuncture is a very popular treatment, a lot of people swear by it. But the massive amount of research that has gone into it has shown it to be nothing more than an elaborate placebo[2]. Positive outcomes are usually the result of poor study design, or are paid for by special interest CAM groups, who will even spin their own negative studies to make it appear more effective on paper. A lot of times, though the title may read that it’s a study of acupuncture, what it’s really studying is TENS or transcutaneous electrostimulation, a valid form of pain relief that is being masqueraded as acupuncture by CAM groups. Classic bait and switch. Unfortunately, the utter volume of these junk studies have tainted the usually-reliable meta-analysis publications, like Cochrane Reviews, and you wind up with sweeping statements like “acupuncture may act as a suitable treatment for _______ (insert preferred malaise here), more research is needed to determine whether acupuncture could be used as an effective alternative to current treatment.”

Right, so now you’re saying, “Yeah, but acupuncture has been in use for thousands of years, has been spread around the globe, and persists today as popular treatment. There has got to be something to it.” Well, actually it hasn’t persisted as long as you may think. According to Wikipedia’s history, acupuncture started to fall out of favor around the 11th century in China. It persevered somewhat as a less prestigious practice, usually attributed to poor, illiterate classes for the next several centuries, declining more so with each generation. European explorers began bringing back the stories of acupuncture and writing books about them in the 17th century, but very few actually experimented with it.

In 1822, an edict from the Emperor Daoguang banned the practice and teaching of acupuncture within the Imperial Academy of Medicine outright, as unfit for practice by gentlemen-scholars. Then, in the early years after the Chinese civil war, Chinese Communist Party leaders ridiculed traditional Chinese medicine, including acupuncture, as superstitious, irrational and backward, claiming that it conflicted with the Party’s dedication to science as the way of progress.[3] It wasn’t until midway through the 20th century, when Mao Zedong called for acupuncture to be valued as an important part of China’s legacy, and reversed its ban (although, Mao himself did not believe in, nor use any Traditional Chinese Medicine).

In the early 1970’s acupuncture got its first major endorsement in America when a reporter for the New York Times gave an enthusiastic testimony for it curing his post-operation pain, and President Nixon visited China where he was subjected to observing a (what we now know was staged) surgery of a patient receiving acupuncture instead of anesthesia (he was really getting morphine through his IV, had a high tolerance for pain, and was instructed not to make any sound during the surgery). Despite other exposed hoaxes falsely showing acupuncture’s benefit, its popularity has grown at an unprecedented level.

There are studies looking at the benefit of acupuncture for symptoms common in CF, namely chest pain, back pain, joint pain, nausea, blocked bowels, and one small pilot study from 2005 that focused on CF in particular. This one, and others like it were from the American Journal of Chinese Medicine, which according to Research Gate has a very low impact factor. In 2005, when the study was published, its impact factor was 0.74, and it’s never been above a 2.28[4]. As far as I can tell, in the 9 years since it was published, it’s never had a larger quantitative follow-up study. This is not very encouraging, as there were no real controls and the results were reported based only off patient pain ratings between 0-10 before and after treatment[5].

Also, as in many of the acupuncture studies, blinded subjects were generally not able to tell between real acupuncture and sham acupuncture- sticking needles in randomly as opposed to the supposedly precise places a certified practitioner would know to do[6]. This just goes to show how strong the placebo effect is. If patients believed they were being healed, they were more likely to respond in a survey as having reduced pain. As Steve Novella writes, “The best controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work.”[7]

Knowing all of this, it makes me wonder how worth it that poke is. With the benefits of acupuncture being practically nil (or at least short-lived), and the risks (though small) still being present, that adds up to a poor risk/benefit ratio. If it were me, I would not want to waste my money on a treatment that ultimately is just in my head, from a person whose medical abilities are possibly lacking.

 

 

[1] http://www.sciencebasedmedicine.org/tcm-hodgepodge/

[2] http://www.sciencebasedmedicine.org/reference/acupuncture/

[3] http://en.wikipedia.org/wiki/Acupuncture#History

[4] http://www.researchgate.net/journal/0192-415X_The_American_Journal_of_Chinese_Medicine

[5] http://www.sld.cu/galerias/pdf/sitios/mednat/acupuncture_pain_management_for_patients_with_cystic_fibrosis.pdf

[6] http://www.ncbi.nlm.nih.gov/pubmed/1816730

[7] http://www.sciencebasedmedicine.org/acupuncture-doesnt-work/