Does Acupuncture Work?

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The previous points are all reasons to be highly skeptical of the claims made for acupuncture, but they are all also trumped by the ultimate consideration - the direct scientific evidence. There is a surprisingly large published literature on the clinical effects of acupuncture. Most people are equally surprised to learn that the literature is essentially negative - probably because the press cherry picks apparently positive studies and re-prints without investigation the press releases of acupuncture proponents.

It is important to evaluate the literature as a whole to see what pattern emerges. The pattern that does emerge is most consistent with a null effect - that acupuncture does not work.

Controlled clinical trials of actual acupuncture (uncontrolled trials should only be considered preliminary and are never definitive) typically have three arms: a control group with no intervention or standard treatment, a sham-acupuncture group (needles are placed but in the "wrong" locations or not deep enough), and a real acupuncture group. Most of such trials, for any intervention including pain, nausea, addiction, and others, show no difference between the sham-acupuncture group and the acupuncture group. They typically do show improved outcome in both acupuncture groups over the no-intervention group, but this is typical of all clinical trials and is clearly due to placebo-type effects. Such comparisons should be considered unblinded because patients know if they were getting acupuncture (sham or real).

The lack of any advantage of real over sham acupuncture means that it does not matter where the needles are placed. This is completely consistent with the hypothesis that any perceived benefits from acupuncture are non-specific effects from the process of getting the treatment, and not due to any alleged specific effects of acupuncture. In other words, there is no evidence that acupuncture is manipulating chi or anything else, that the meridians have any basis in reality, or that the specific process of acupuncture makes any difference.

More recent trials have attempted to improve the blinded control of such trials by using acupuncture needles that are contained in an opaque sheath. The acupuncturist depresses a plunger, and neither they nor the patient knows if the needle is actually inserted. The pressure from the sheath itself would conceal any sensation from the needle going in. So far, such studies show no difference between those who received needle insertion and those who did not - supporting the conclusion that acupuncture has no detectable specific health effect.

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study, the smaller the effect, and the best controlled trials are negative. This pattern is highly predictive of a null-effect - that there is no actual effect from acupuncture.