Of all the alternative therapies, acupuncture is perhaps the best known.
Almost everyone seems to have heard that it is ancient, from China, and involves sticking needles into particular points along lines called ‘meridians.
But does it work? To answer this dilemma depends on the person you ask.
Sure it works, say the skeptics – it’s a powerful placebo, but it has no effects beyond that.
By contrast, some physicians claim that it is helpful for a limited range of conditions yet admit that the result is far from impressive.
And an acupuncturist might explain that therapy would not have survived thousands of years if it were not effective – it rebalances the body’s life-energy.
It, therefore, works for any condition that afflicts humans. Yes, the realm of acupuncture is rife with opinions and fallacies – and short on certainties.
The popular argument that any treatment which has ‘stood the test of time’ must also be good, for instance, is a classic fallacy that regularly misleads many of us.
If we want to know the truth, we better look for some tangible evidence – and, in medicine, that means results of clinical trials.
Thousands of such studies are currently available. At the first moment, It seems like good news, but oddly it is yet another source of confusion
the vast majority of these trials are of such poor quality that they tell us next to nothing.
Moreover, several investigations have demonstrated that virtually all studies originating from China arrive at positive conclusions – their reliability is thus less than encouraging.
Even if we only assess the seemingly rigorous studies, the picture does not become much clearer.
For every trial suggesting that acupuncture works for this or that condition, at least one further study shows the exact opposite.
In search of evidence
It is tempting to select those results that seem to confirm our preconceived ideas and discretely forget about the rest in a situation like this.
However, cherry-picking is a hallmark of the pseudoscience of which acupuncture, like all alternative medicine, has more than its fair share.
If we are interested in the truth, we must always critically evaluate the available evidence’s totality. This is best done by conducting a ‘systematic review.
Most experts agree that, among systematic reviews, so-called Cochrane Reviews are second to none – they are regularly updated to the highest standards by independent
experts in a transparent fashion.
Today, numerous Cochrane Reviews are available, summarising the evidence for acupuncture as a treatment of specific conditions.
What’s evident from these publications is fairly obvious -acupuncture has been studied for a wide range of conditions, and critical assessments of the findings rarely, if ever, generate a convincingly positive verdict.
How could it work? Given that we cannot be sure whether acupuncture works, it seems almost futile to ask, “how does it work?”
It is only fair to mention that several theories regarding acupuncture’s mode of action have been formulated.
Traditional acupuncturists tend to adhere to the old Chinese myth that acupuncture works by re-balancing our life-forces when they have become unbalanced.
Western acupuncturists, by contrast, are keen on suggestions that acupuncture affects neurophysiological pathways, for instance, by boosting the level of endorphins inside the brain.
Skeptics would, however, insist that these notions are mere theories. The explanation for both the evidence from clinical trials and the millennia of experience is much simpler –
acupuncture has all the qualities of a powerful placebo, as it’s exotic, invasive, mildly painful, and involves touch and time with a therapist.
The main thing is not the mechanism of action, but acupuncture helps patients, even if the benefit heavily relies on placebo and other non-specific effects.
In this case, do we really need acupuncture? We could maximize the placebo effect the best while simultaneously administering treatments that truly work, such as effective therapies beyond placebo.
According to the best evidence available, acupuncture does not fall into this category. The slightly paradoxical thing is, we do not need placebo therapies for generating placebo effects
giving effective treatments with compassion and empathy also generates placebo effects and an almost inevitable bonus to any intervention.
In other words, the placebo effect is no justification for employing these treatments -otherwise, we open the door to all sorts of quackery to the detriment of effective healthcare.
The trump card
Time to play the last trump card in the hands of acupuncture fans – safety. At least, our treatment cannot cause any harm, they claim.
Again, skeptics are not impressed by this argument and stress that this statement is based more on wishful thinking than sound evidence.
Even Chinese acupuncturists recently agreed with this view. They summarised all the adverse events of acupuncture ever published in the Chinese literature and found 1,038 cases of serious adverse events, including 35 fatalities and hundreds of potentially life-threatening complications.
To put this into context, in general, Chinese publications are strongly biased in favor of acupuncture, as shown by an article in Controlled Clinical Trials.
Thus the level of under-reporting must be assumed to be huge, and the true figure of adverse effects caused by acupuncture could be much bigger.
From large studies done in the West, we know that about 10 percent of all patients will experience mild to moderate adverse effects after acupuncture.
The most frequent type of serious complication is caused by an acupuncture needle piercing internal organs, such as the lungs or the heart.
If we add to all this the risks of false diagnoses through the obsolete techniques used by traditional acupuncturists, it’s impossible to deny that acupuncture has considerable potential to do serious harm.
A fine line
Considering the complexities, myths, fallacies, uncertainties, and confusions around the topic, it is not easy to develop any clear recommendations for those who are nevertheless tempted to try acupuncture.
So if you’re planning on giving it a shot, it’s worth bearing a few things in mind. It is often claimed that acupuncture has ‘stood the test of time; and that its long history proves its effectiveness and safety.
This argument is as popular in the realm of alternative medicine as it is misleading. A long history of usage proves very little – think of bloodletting used for millennia, even though it killed thousands.
Secondly, we often think of acupuncture as one single treatment, but there are numerous different forms of this therapy and many therapists.
Traditional Chinese acupuncturists have not normally studied medicine. They base their practice on the Taoist philosophy of balancing life forces and could use non-scientific diagnostic methods.
In contrast, medical acupuncturists tend to cite neurophysiological explanations as to how acupuncture might work.
However, these may appear scientific and plausible; however, they are just theories and constitute no proof for acupuncture’s validity as a medical intervention.
And then, there are the therapeutic claims made for acupuncture, which are mostly unfounded.
According to the traditional view, acupuncture is useful for virtually every condition affecting humankind.
But according to the more modern view, it might be effective for just a minimal range of conditions.
Once we critically examine the reliable evidence, we realize that acupuncture relies heavily on a powerful placebo effect.
The question of whether it has effects beyond placebo has so far not been answered conclusively. Few acupuncturists seem to warn their patients of possible adverse effects.
Yet minor side effects occur in about 10 percent of all patients, and numerous serious complications are on record.
Well over 100 fatalities have been reported in the medical literature – a figure that may represent the tip of a considerably bigger iceberg due to the lack of a monitoring system.
Given that there is little good evidence that acupuncture works beyond a placebo response and that acupuncture is associated with finite risks, it seems to follow that, in most situations, the risk and benefit balance for this treatment fails to be convincingly positive.