Critical Thinking on Acupuncture
How Does it Work?


1. Acupuncture

Acupuncture is a form of traditional Chinese medicine that is used to try to cure disease, infections and pain as well as curing psychological problems. Traditional practitioners say this is done by rebalancing the Yin and Yang, unblocking Chi, along with various other mystical explanations. In mainstream medicine, acupuncture is known to work as a form of pain relief. Headaches and migraines are the main reasons that a GP might refer a patient for acupuncture1. 6 million people in Britain suffer from migraines2.

Book Cover[Acupuncture] is an ancient Chinese medical procedure in which long needles are inserted into specific points at the skin. The traditional Chinese explanation is that the needles bring Yin and Yang (which flow through [...] meridians) into harmony with each other.

"The Oxford Companion to the Mind" by Richard L. Gregory (1987)

Scientific evidence on acupuncture discredits it almost entirely, especially "traditional" forms of it for the main reason that sticking pins in "randomly" (ignoring traditional methods) is just as effective, and, tricking the patient into thinking they are receiving acupuncture is actually just as effective as actually giving it. Hence, it is known to operate by the placebo effect, where patients simply make themselves feel better via internal psychological controls.

Acupuncture is therefore one amongst the range of "alternative therapies" which run counter to science.

In the USA up to 4 in ten adults use 'some form' of alternative therapy3. In Britain there are about 150 000 alternative therapists, and the public spend about £4.5 billion on them (as of year 2009)4. In nearly all practices, they work due to the psychology surrounding 'treatment' (the placebo effect) rather than the actual result of the treatment. Nearly all alternative therapies are psychological trickery rather than real medicine. All such practices are called quackery by skeptics. The danger is that many people seek help from 'alternative' providers before they seek proper medical help, which can result in delayed treatment and in the worst cases, death from ailments that are otherwise perfectly curable if only the sufferer had gone to a normal doctor sooner3.

"Pseudoscience and Health: The World of Alternatives (to Truth)" by Vexen Crabtree (2014)

2. Scientific Studies of Acupuncture

In 2005, at least 26 randomized controlled trials have been published showing no convincing effect of acupuncture on headaches, and these represented nearly all of the adequate scientific studies on the subject5. In 2012 it was confirmed again by a number of scientists that "acupuncture is no more effective than placebo. It showed that patients were more likely to improve if they believed in acupuncture and believed they got the real thing rather than a placebo, regardless of which one they actually got"6. Three older studies containing a few hundred patients in each one have found statistically significant reductions in the amount of headaches suffered by acupuncture patients. For example:

The British Medical Journal reported on a 2 year study from 1999-2001 involving 401 participants. A 34% reduction in headaches from the baseline was achieved using acupuncture1. So how can it be that some studies show positive effects, whereas most others do not? Ben Goldacre studied the evidence surrounding acupuncture and found that properly controlled studies show no advantage of acupuncture above the placebo effect, but poorly controlled studies where psychological factors are not properly accounted for end up showing that acupuncture is effective.7. Poor experimental design can have real effects - and in this day and age where most news outlets don't have scientifically qualified staff that examine trials before they are printed, this means that large numbers of people can be easily duped into trusting something that ought to be debunked. Two example studies which have found results which practitioners of alternative medicine and experts have suspected for a long time, are:

It can be seen that studies are telling us that something is wrong with acupuncture. Its effects are not what they should be.

Scientific studies over the past few years have supported my original position: the beneficial effects of acupuncture and other forms of energy medicine are probably due to a combination of expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms. Similar results have been obtained for true acupuncture, sham acupuncture (pretending to stick needles into a person), acupressure (where acupoints are touched but not needled), reiki and therapeutic touch (where the therapist allegedly manipulates chi without touching the patient at all), Tong Ren (a kind of voodoo acupuncture where one strikes acupoint marks on a doll with a hammer to release energy), and distant healing (where the healer doesn't need to be in the physical presence of the patient). Apparently, as long as the patients believe they are getting energy treatment, they get some relief, but it doesn't really matter whether the patient is stuck with needles, touched or not, or even in the presence of the healer. Of course, there is no way to disprove the claims that coming near the acupoints, thinking about them, or hitting effigies of them triggers the unblocking of chi. But such explanations seem superfluous when there are simpler explanations that can plausibly account for the same data: placebo effects.

"Unnatural Acts: Critical Thinking, Skepticism, and Science Exposed!"
Robert Carroll (2011)8

See: What is Science and the Scientific Method? for descriptions of the scientific method and howto circumvent common errors in human theorizing.

3. The Placebo Effect9

So, we have seen that scientific and medical studies have found that acupuncture works by the placebo effect. What is that? Our explanations starts with a few comments from the critical thinker Robert Carroll:

Book CoverIt's clear from the testimonial and scientific evidence that acupuncture benefits some people some of the time for some conditions, particularly for the relief of pain. It's also clear that acupuncture doesn't benefit anyone for some conditions. [...] Acupuncture is a placebo therapy: the effects of acupuncture are not significantly different from the effects of placebos or of making no intervention.

"Unnatural Acts: Critical Thinking, Skepticism, and Science Exposed!"
Robert Carroll (2011)8

The placebo effect is a positive effect on an illness or medical condition, or on a health-related outcome, that results from suggestion and expectation10. This subtle psychological effect occurs whether or not the underlying treatment actually works and it is strong enough to continually distort medical studies into the effectiveness of health products and can make products seems effective when they are not - it can even do the same for surgical practices.11,12. Such unexpected effects have been studied in greater and greater detail by medical researchers, and it has emerged that placebo effects come in various forms13. The placebo effect is particularly significant in areas such as pain relief and stress, and is therefore best at overcoming aches and pains, headaches, stress-related conditions including recovery from stomach ulcers10 and skin rashes. Most complementary and alternative medicines (CAM) and alternative therapies work through indirect psychological effects, and the placebo effect is the reason why these remedies appear to work for so many people, when in reality they don't have any medical effect14,15,16,17,18,19,20,21 and its effects can often support erroneous ideas as to how disease works, and how healing works.

How does it work? (1) There is a link between mood and mental states of mind, and between mood and our immune system, meaning, that our overall impressions of a treatment can affect our outlook, which can boost our immune system22,23,24. (2) When it comes to pain, the prefrontal cortex of the brain can suppress pain messages from the insula25 and other places, meaning that if we prime ourselves to feel less pain (such as when expecting a pill to work) then it really does dull pain. Many experiments have confirmed the ability of people to mentally control pain. (3) Classical conditioning means that many elements of merely receiving a treatment cause our brain to release neurotransmitters and other learned responses in anticipation of feeling better, which improves how we feel11,20. (4) The Hawthorne Effect - people tend to live healthier and perform better simply because they are being studied15,20. (5) Receiving treatment can boost confidence and reduce stress, both of which can improve healing and feelings of wellbeing11,20,26.

4. Traditional Explanations of Acupuncture are Mumbo Jumbo

Seven years before these significant findings, Adrian White wrote of the "reappraisal" of Western acupuncture:

In the last 30 years, a fundamental reappraisal has been taking place in the Western world. This reappraisal has been occurring largely in the UK in the wake of Felix Mann's pioneering declaration that acupuncture points don't exist, acupuncture meridians don't exist, but acupuncture still works. He was expressing the secret thoughts of many people who were trained in both biomedicine and acupuncture, who could not come to terms with the traditional way in which acupuncture was applied but could see that it could be very effective.

Adrian White (1998)27

Carroll (2011) reports that acupuncture practitioners themselves do not have a consistent grasp of the theory - ailments are diagnosed and acupuncture points proscribed completely differently according to who you ask, even when they are all examining the same patient with an underlying simple cause of pain. Acupuncture in China has a completely different set of norms to that practiced in Korea or Japan or elsewhere. All of this is because the underlying theory is incoherent and not based on evidence.

R. Barker Bausell, an expert in biostatistics, served for five years as the director of research at the University of Maryland's NIH-funded Complementary Medicine Program (now called the Center for Integrative Medicine). He found it disconcerting that there was no consistency in either diagnosis or treatment recommendations among three experienced TCM (traditional Chinese medicine) physicians who examined the same group of patients identified as having rheumatoid arthritis. [...]

The fact that three experts would disagree so fundamentally about diagnosing and treating the same patients, even when they knew that the patients all suffered from the same disease, led him to conclude that even if there is some physiological basis for acupuncture, it would be worthless. Why? Because highly trained experts came up with completely different conclusions when examining the same patients.

"Unnatural Acts: Critical Thinking, Skepticism, and Science Exposed!"
Robert Carroll (2011)8

With the further revelations that sticking pins in randomly is as effective as acupuncture using traditional mystical practices, it seems that Felix Mann's sensible proclamation is now more comprehensively proven to be correct. What has been discovered by scientists is that the nervous system can be stimulated at myofascial 'trigger points' which are already known to Western medicine, and that this sometimes works as a neural pain inhibitor, in the same way that scientific procedures such as transcutaneous electrical nerve stimulation (TENS) works.

These findings have not been confined to modern "Western" countries. After the dawn of medical science in China and Japan, acupuncture found itself increasingly censored and in some places banned in its home countries, because of its medical record.

By 1911 in China acupuncture was no longer a subject for examination by the Chinese Imperial Medical Academy. [...] It might be of interest to some readers that The National Council Against Health Fraud (NCAHF) found that of the forty-six medical journals published by the Chinese Medical Association, not one is devoted to acupuncture or other traditional Chinese medical practices.

"Unnatural Acts: Critical Thinking, Skepticism, and Science Exposed!"
Robert Carroll (2011)8

Combine this with the many studies into Traditional Chinese Medicine and acupuncture mentioned by Stephen Barrett28 and it seems that acupuncture is an unacceptable practice, especially because those who are involved as patients are not informed of its dubious nature, but are actively encouraged to think of acupuncture in rose-tinted, supernatural terms. Until it is medicalised, it remains quackery.

5. Slow Conducting Unmyelinated Afferents

Part of the scientific process of controlled trials is a method by which you see if the treatment is making people better, or, if psychologically the people are getting better because they think they're getting treated. As a result, all trials should have a control where a similar "fake" placebo treatment is offered. This has shown to be the best technique for medical trials, especially when combined with "double-blinding" so that the experimenter himself does not know which treatment is true and cannot accidentally give away clues to the patients. Only the experiment controller knows, who has no contact with the patients directly. In studies of acupuncture, it has consistently been shown by scientists that real acupuncture is only as good as a placebo and there is certainly no advantage to actually having pins stuck in you: fake pins that look like they puncture the skin (but actually the retract inside themselves) have been just as good as real pins. The following extract shows why it is that this minimal skin contact can still have a positive effect on patients:

Most controlled trials of acupuncture have used minimal, superficial, sham or 'placebo' acupuncture. It has recently been demonstrated that light touch of the skin stimulates mechanoreceptors coupled to slow conducting unmyelinated (C) afferents resulting in activity in the insular region, but not in the somatosensory cortex. Activity in these C tactile afferents has been suggested to induce a 'limbic touch' response resulting in emotional and hormonal reactions. It is likely that, in many acupuncture studies, control procedures that are meant to be inert are in fact activating these C tactile afferents and consequently result in the alleviation of the affective component of pain. This could explain why control interventions are equally as effective as acupuncture in alleviating pain conditions that are predominantly associated with affective components such as migraine or low back pain, but not those with a more pronounced sensory component, such as osteoarthritis of the knee or lateral epicondylalgia.

Acupuncture in Medicine journal (2006)29

6. Risks and Dangers of Acupuncture

Dr Barrett summarizes:

The adverse effects of acupuncture are probably related to the nature of the practitioner's training. A survey of 1,135 Norwegian physicians revealed 66 cases of infection, 25 cases of punctured lung, 31 cases of increased pain, and 80 other cases with complications. A parallel survey of 197 acupuncturists, who are more apt to see immediate complications, yielded 132 cases of fainting, 26 cases of increased pain, 8 cases of pneumothorax, and 45 other adverse results. However, a 5-year study involving 76 acupuncturists at a Japanese medical facility tabulated only 64 adverse event reports [...] associated with 55,591 acupuncture treatments. [...] The researchers concluded that serious adverse reactions are uncommon among acupuncturists who are medically trained.

"Acupuncture, Qigong, and Chinese Medicine", Stephen Barrett (M.D.)28

And Robert Carroll:

The danger from acupuncture is that it is being promoted as superior to scientific medicine, when in fact it is clearly inferior. Acupuncture is touted as appropriate for almost any disorder or disease in man or beast, when the evidence clearly shows that such a belief is a dangerous delusion. People go to acupuncturists for treatment of AIDS, allergies, arthritis, asthma, Bell's palsy, bladder and kidney problems, breast enlargement, bronchitis, colds, constipation, cosmetics, depression, diarrhea, dizziness, drug addiction (cocaine, heroin), epilepsy, fatigue, fertility problems, fibromyalgia, flu, gynecologic disorders, headaches, high blood pressure, hot flushes, irritable bowel syndrome, mental illness, migraines, nausea, nocturnal enuresis (bedwetting), pain, paralysis, post-traumatic stress disorder (including rape victims), PMS, sciatica, sexual dysfunction, sinus problems, smoking, stress, stroke, tendonitis, vision problems, and just about anything else that might ail a human being.

"Unnatural Acts: Critical Thinking, Skepticism, and Science Exposed!"
Robert Carroll (2011)8

7. Conclusion

At least 26 studies of acupuncture have shown that it has no significant effect. But, three large studies have found that acupuncture does reduce the incidence of headaches and migraines. But two of those have shown that sticking pins in randomly is as effective as using traditional Chinese methods. Scientists understand how the neural and hormonal stimulation of needles work in a biochemical way to sometimes produce the results of acupuncture. What is known now is what has been suspected by practitioners for a long time: the traditional talk of "energy channels", "meridians" and "acupuncture points" amongst other spiritual and mystical explanations are all untrue, discredited and defunct explanations of how acupuncture works. Instances of punctured lungs, increased pain, internal bleeding and other side-effects occur in up to 1 in 5 cases especially if a practitioner is not a medically trained doctor. It works for pain relief for medically known reasons and due to the placebo effect30, but the traditional mumbo-jumbo associated with traditional acupuncture is best ignored.

Read / Write LJ Comments

By Vexen Crabtree 2005 Aug 13
(Last Modified: 2015 Sep 06)
http://www.humantruth.info/acupuncture.html
Parent page: Human Health and Self Development

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References: (What's this?)

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The Economist. Published by The Economist Group, Ltd. A weekly newspaper in magazine format, famed for its accuracy, wide scope and intelligent content. See vexen.co.uk/references.html#Economist for some commentary on this source.

Skeptical Inquirer. Pro-science magazine published bimonthly by the Committee for Skeptical Inquiry, New York, USA.

Carroll, Robert Todd. Taught philosophy at Sacramento City College from 1977 until retirement in 2007. Created The Skeptic's Dictionary in 1994.
(2011) Unnatural Acts: Critical Thinking, Skepticism, and Science Exposed!. Kindle edition. Published by the James Randi Educational Foundation.

Davison & Neale
(1997) Abnormal Psychology. Hardback 7th edition. Published by John Wiley & Sons, Inc. Amazon link points to a newer edition than the one I've used here.

Gardner, Martin. Died 2010 May 22 aged 95.
(1957) Fads & Fallacies in the Name of Science. Published by Dover Publications, Inc., New York, USA. Originally published by G. P. Putnam's Sons in 1952 as "In the Name of Science".

Goldacre, Ben. MD.
(2008) Bad Science. Published by Fourth Estate, an imprint of HarperCollins Publishers, London, UK.

Gregory, Richard L.
(1987) The Oxford Companion to the Mind. Oxford University Press, Oxford, UK. Quotes from 1987 reprint.

Gross, Richard
(1996) Psychology: The Science of Mind and Behaviour. 3rd edition. Published by Hodder & Stoughton, London UK.

James, William. (1842-1910)
(1902) The Varieties of Religious Experience. Subtitled "A Study in Human Nature". From the Gifford Lectures delivered at Edinburgh 1901-1902, first Edition printed 1960. Quotes from fifth edition, 1971, Collins and from Amazon digital Kindle version of the 2015 Xist Publishing edition. [Book Review]

Lehrer, Jonah
(2009) The Decisive Moment: How the Brain Makes Up Its Mind. Hardback. Published by Canongate Books, Edinburgh.

Myers, David
(1999) Social Psychology. 6th 'international' edition. First edition 1983. Published by McGraw Hill.

Novella, Steven Dr
(2010) "The Poor, Misunderstood Placebo". Published in Skeptical Inquirer (2010 Nov/Dec) p33-34. Novella is assistant professor of neurology at Yale School of Medicine and President of the New England Skeptical Society.

Toates, Romero & Datta
(2004) From Cells to Consciousness. A neurology textbook by Frederick Toates, Ignacio Romero and Saroj Datta. Published by The Open University, Milton Keynes, UK.

Footnotes

  1. British Medical Journal (2004 Mar 27) article BMJ 328:744-7 entitled "Acupuncture for chronic headache in primary care: large, pragmatic, randomized trial".^^
  2. BBC News (TV) (2005 Jan 17).^
  3. The Economist (2012 Apr 14) article "Medicine and its Rivals".^
  4. The Economist (2009 Jan 24) article "Regulating alternative medicine" p35.^
  5. The Independent (2005 Jul 29), British intellectual broadsheet newspaper, article "Traditional Chinese acupuncture may have no point, research finds" p23. By Jeremy Laurance, Health Editor.^
  6. Skeptical Inquirer (2013 Jul/Aug) article Down the Garden path: Faulty Thinking and Self-Delusion p32-35, by Harriet Hall, MD. The authors cites the following study: White, P., F.L. Bishop, C. Scott, et al. (2012). "Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture" in Pain 153(2): 455-62. Added to this page on 2014 Jun 30.^
  7. Goldacre (2008) digital location 725-730,748, 773. Added to this page on 2015 Sep 06.^
  8. Carroll (2011) Appendix C: Acupuncture, CAM (complementary and alternative medicine), and Faith, p234-250. Added to this page on 2014 Jun 30.^^^^
  9. Added to this page on 2014 Jun 30.^
  10. NHS article The placebo effect and complementary and alternative medicine" (not dated, but "last reviewed" on 2016 Feb 03). Accessed 2016 Apr 16.^
  11. Goldacre (2008) chapter 5, "The Placebo Effect".^
  12. Toates, Romero & Datta (2004) p6-7, 38-39^
  13. Goldacre (2008) digital location 594.^
  14. "Pseudoscience and Health: The World of Alternatives (to Truth)" by Vexen Crabtree (2014)^
  15. Goldacre (2008) chapter 8 "Pill Solves Complex Social Problem", digital location 1994-2009.^
  16. Carroll (2011) p154, 251.^
  17. Gardner (1957) p187.^
  18. The Economist (2012 Apr 14) article "Medicine and its Rivals".^
  19. Toates, Romero & Datta (2004) p6-7, 38-39.^
  20. Novella (2010).^
  21. James (1902) p108 footnote.^
  22. Gross (1996) p145.^
  23. Davison & Neale (1997) p202.^
  24. Scientific American Mind (2009 Sep/Oct) article "Inflammation Brings on the Blues" p16.^
  25. Lehrer (2009) p143.^
  26. Myers (1999) p583.^
  27. Adrian White "A Reappraisal of Acupuncture" (1998) article was originally published in Vol.2, Issue 5, of the Complementary Therapy Update and was accessed online at www.medical-acupuncture.co.uk/articles/white1.shtml .^
  28. Stephen Barrett (M.D.). "Acupuncture, Qigong, and Chinese Medicine" accessed at www.quackwatch.org/01QuackeryRelatedTopics/acu.html on 2005 Aug 13.^^
  29. Acupuncture in Medicine journal article "Are minimal, superficial or sham acupuncture procedures acceptable as insert placebo controls?" (2006 March) Vol.24(1):13-15.^
  30. Goldacre (2008) digital location 731. Added to this page on 2015 Oct 01.^

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