Wednesday, 8 October 2008

Acupuncture - some of the facts

I pity the targets of this negative article on acupuncture. For instance, did you know that:

... this ancient Chinese treatment is not so ancient and may not even be Chinese! From studying the earliest documents, Chinese scholar Paul Unschuld suspects the idea may have originated with the Greek Hippocrates of Cos and later spread to China. It’s definitely not 3000 years old. The earliest Chinese medical texts, from the 3rd century BC, do not mention it. The earliest reference to “needling” is from 90 BC, but it refers to bloodletting and lancing abscesses with large needles or lancets. There is nothing in those documents to suggest anything like today’s acupuncture. We have the archaeological evidence of needles from that era — they are large; the technology for manufacturing thin steel needles appropriate for acupuncture didn’t exist until about 400 years ago.

Of course, while this is amusing, it doesn't dent acupuncture's credibility on its own. Fear not, though, for the article is showered with paragraphs like this:

Acupuncture works in the same manner that placebos work too. Acupuncture has been shown to “work” to relieve pain, nausea, and other subjective symptoms, but it has never been shown to alter the natural history or course of any disease. It’s mostly used for pain today, but the ancient Chinese maintained that it was not for the treatment of manifest disease, was so subtle that it should only be employed at the very beginning of a disease process, and was only likely to work if the patient believed it would work. Now there’s a bit of ancient wisdom!

What do trials say, though? As the author here rightly points out, acupuncture has received mixed trial results, but there have been some positive ones. The real problem is that it is virtually impossible to properly control for the placebo effect. Usually this is accomplished by randomly, and secretly, assigning the patients into two groups - one which gets the real thing and one which gets the placebo. The trick is that the placebo must look and taste and feel and smell and (you get the picture) exactly the same as the real deal so that the patient (and usually the administering doctor) can't tell the difference. With acupuncture this is all but impossible, since most people are quite able to tell whether or not they are having needles stuck into their skin! This problem means that any purported positive trials must nonetheless be viewed with a high degree of suspicion, since they can't really exclude the placebo effect.

My conclusion, at present, is that acupuncture may or may not work, but that in the absence of strong evidence to support its claims, we should remain sceptical. Of course, things like meridian lines or "qi" are nonsense, and have been refuted conclusively in trials, so we can safely jettison them.

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