Clinical Trials Show That Acupuncture Does Not Work
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.
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By just looking at how many drugs have been recalled one can see that science doesn't have the whole picture all the time. You know, people figured out what activity made babies happen long before they knew the entire story about mechanisms (and even now the whole story is not known). The fact that patients get better much of the time for having received competent acupuncture treatment is significant if one's intention is to relieve suffering in patients. If compelling scientific proof is one's motivation, then I can understand that not being able to explain results would be very unsettling. However, let's not forget that as physicians, our goal should be the relief of suffering--not neatly packaged results. And if our patients are reporting to us in droves that acupuncture has helped them where allopathic medicine could not, perhaps we, as physicians, should be thankful that someone is helping our patients. They certainly are.
smc
"By just looking at how many drugs have been recalled one can see that science doesn't have the whole picture all the time."
That is Science in action. Drugs are tested rigorously, but testing is by its very nature limited, and released once the testing passed. Once introduced into the general population more studies are done to see if it is effective or harmful, when found to be harmful a drug is removed from the population. That drugs are removed is a sign that the process is working.
"The fact that patients get better much of the time for having received competent acupuncture treatment is significant if one's intention is to relieve suffering in patients."
Yet studies have shown that random sticking with needles works just as well as acupuncture... indeed every rigorous study done on acupuncture has shown that it's effects are no better then a placebo.
"If compelling scientific proof is one's motivation, then I can understand that not being able to explain results would be very unsettling."
It's not unsettling, it is exciting... that means that something new is being observed. A researcher who would be able to demonstrate a mechanism behind acupuncture would be rather famous indeed.
"Yet studies have shown that random sticking with needles works just as well as acupuncture ...indeed every rigorous study done on acupuncture has shown that it's effects are no better than a placebo."
The NIH has finally agreed that placebo acupuncture treatments or "random sticking" as you call it, are not truly placebo. One is still stimulating the body. Research is going more toward practice based studies for this and other reasons--mainly because it has been determined that acupuncture does have an effect. Now it's time to study which practitioners are getting what results with what kinds of cases.
"That drugs are removed is a sign that the process is working."
Really? Experimenting on people with unproven drugs, finding out that they kill or hurt a significant number of patients, then removing them from the market means the process works? How many people have been killed or hurt by acupuncture compared to how many helped and how many no effect? Lets look at those numbers. Medication and surgery should be the last resort. Both irrevocably injure the body. All medications are toxic and must be detoxified by the liver and/or kidneys which causes strain on our systems. While acupuncture is not risk-free, the number of deaths and injuries are miniscule in comparison. And the success rate according to users is significant. Isn't it just common sense??
"A researcher who would be able to demonstrate a mechanism behind acupuncture would be rather famous indeed."
The suggested mechanisms for acupuncture are as varied as it's effects. Because the approach is so different from the western model where we target and isolate, one cannot ask the same questions nor perform the same experiments. For example, when studying Desert Ecology one has little need of a microscope. But does that mean it is not science ? Acupuncture is about stimulating areas of the body which are related embryologically (the arms to the heart/lungs) to get a distant effect (or local effect as the case may be). There is a holographic system at work as well (just like the DNA for our whole body is located in the nucleus of each cell). Please refer to Matsumoto and Birch's Hara Diagnosis: Reflections on the Sea, especially chapters 8 and 9 for an overview of possible mechanisms beyond the simple gate theory of pain. And why it is untenable to prove these mechanisms at this time.
It took mankind over 1 million years to answer some of the questions concerning conception. But as I stated before, that didn't stop us from using the same time tested techniques to procreate.
The human body's (or any life form's) ability to adapt and heal itself is in large part what has permitted it to persist. Acupuncture (or any of the many methods of stimulating acupoints) is just one way to help steer living things toward health using the body's ability to adapt to stimuli. It can be done correctly (points chosen wisely for each patient) and the patient made better. Or points can be chosen unwisely and the patient's health can be worsened more quickly than would have otherwise happened. I urge you to read more about it from the acupuncture community itself--not just "studies". The studies are like monkeys coming upon a spaceship and beating on it with sticks and rocks to try to see if it fights back or they can eat it. It's far too advanced systems theory to use reductionist thinking on.
A reading list for those who are interested:
In this order:
The Body Electric---R.O. Becker MD--Interesting stuff on tissue healing and polarity at injury (needle stick) sites and references to possible mechanisms for acupuncture
The Holographic Universe---Stanislov Groff--pimer on holographic theory which is big in neurobiology these days
Hara Diagnosis: Reflections on the Sea; chapters 8 and 9--Matsumoto/Birch
The Web That Has No Weaver---Ted Kaptchuk
Our health/disease is the gestault of many interacting systems and circumstances, internal and external. Reducing acupuncture to one mechanism is ludicrous. When the body is stimulated, it adapts and responds in myriad ways. The points are like areas on a huge holigraphic multidimensional map which feedback simultaneously to many systems at once and work in concert with other points as well to try to help the body return to the default state of health. Traditionally, it takes a lifetime to study and understand. It must be formally studied as a whole in order to be applied or understood.
Western science is not advanced enough to study acupuncture. Traditional Chinese Medical Theory, on the other hand, has a lot to offer to western medicine as to how the human body works, why it gets sick or well and how to prevent or treat illness before the damage becomes irreversible. Will we listen?
smc
"It can be done correctly (points chosen wisely for each patient) and the patient made better. Or points can be chosen unwisely and the patient's health can be worsened more quickly than would have otherwise happened."
Then that can be observed and tested... Though again, random pricking has been shown to statistically have the same effect as acupuncture .
"I urge you to read more about it from the acupuncture community itself--not just "studies". "
Why doesn't the acupuncture community put out its own studies detailing their methodology. If they did then it would be possible for others to independently verify their work.
"The Body Electric"
If it is electrical based then we can surely test and observe it... also are there any peer reviewed papers on that? The only book I could find was a popular science one, and the only website talked about 'erotic energy ' and described what sounded like a big orgy.
"The Holographic Universe"
This one is a bit better, but it still falls way short... on the page "the Universe as a Hologram" five sentences in is a huge error (separated quantum particles have not been shown to communicate with each other).
"Hara Diagnosis: Reflections on the Sea"
All I find are websites selling the book... no descriptions of how it works or links to published studies.
"The points are like areas on a huge holigraphic multidimensional map which feedback simultaneously to many systems at once and work in concert with other points as well to try to help the body return to the default state of health. Traditionally, it takes a lifetime to study and understand. It must be formally studied as a whole in order to be applied or understood."
Yet you have provided no evidence to demonstrate that that 'huge holographic multidimensional map' even exists.
"Western science is not advanced enough to study acupuncture. "
That's a bit of a dodge there... if acupuncture is impacting the body then that impact can be observed / quantified. Thus Western Science can study acupuncture.
"Traditional Chinese Medical Theory, on the other hand, has a lot to offer to western medicine as to how the human body works, why it gets sick or well and how to prevent or treat illness before the damage becomes irreversible. Will we listen?"
To a practice that recommended the powdered genitals of an endangered species as a treatment for impotence?
"The NIH has finally agreed that placebo acupuncture treatments or "random sticking" as you call it, are not truly placebo. One is still stimulating the body. Research is going more toward practice based studies for this and other reasons--mainly because it has been determined that acupuncture does have an effect. Now it's time to study which practitioners are getting what results with what kinds of cases."
Again, random pricking produced the same results as those found in an actual acupuncture session.
"Really? Experimenting on people with unproven drugs, finding out that they kill or hurt a significant number of patients, then removing them from the market means the process works?"
Yes, because no drug trial can cover everyone who will be taking the drug there will always be some elements unaccounted for. It is tragic but true... with the alternative being those who benefit from the drug not having it (and possibly dying)
"How many people have been killed or hurt by acupuncture compared to how many helped and how many no effect?"
Since acupuncture is doing nothing more then stimulating minor endorphin releases then there isn't much chance of it directly harming. However when an individual forgoes actual treatment for the sake of unproven woo then they are harming themselves.
"Both irrevocably injure the body. All medications are toxic and must be detoxified by the liver and/or kidneys which causes strain on our systems."
[Citation Needed] on that one. While it is possible for medications do damage the body when used in high doses or for long periods of time that damage is part of the testing process. Can you show that a significant portion of medications do long term damage to the body when used?
"Isn't it just common sense??"
Common sense is not always the most useful guide. Indeed when conducting medical research it is important to observe and verify.
"The suggested mechanisms for acupuncture are as varied as it's effects. Because the approach is so different from the western model where we target and isolate, one cannot ask the same questions nor perform the same experiments."
But the points and the channels are real. By stimulating those points we can observe the location where the change is supposed to be taking place to see the effectiveness of acupuncture. The link has a physical presence, and thus can be observed if it exists.
"For example, when studying Desert Ecology one has little need of a microscope."
And? Just because not every scientific tool is useful in every scientific branch (and microscopes are useful in Desert Ecology) does not mean that there are no tools that can be used to study acupuncture.
One of the problems not discussed here concerns how feasible it is to conduct the studies upon acupuncture. The very nature of confining an acupuncture treatment to a certain protocol which can then be assessed in a trial "de-natures" the acupuncture treatment. To rely on a protocol has been historically considered a very inferior form of acupuncture. The sham acupuncture used in many trials is also problematic. For example, techniques of Japanese Acupuncture rely on very superficial insertion, akin to the sham techniques.
It is my view that the gold standard of the RCT is not suitable to properly assess the eficacy of acupuncture. An acupuncture point is not the same as a drug.
I hope that Dr. Novella only tries to instigate a discussion about the topic, and not really believes what he is saying. There many instances in which the same argument (all of his arguments) can be made about the "scientific" approach of Western medicine - and its non-functioning.
However, if he needs more information, I would recommend that he contacts the NIH (National Institute of Health) and get their opinion on the subject.
Furthermore, there are many studies conducted by large Medical Centers in the US and Europe (Mount Sinai, Boston Memorial, for example) on the efficacy of acupuncture and the results are outstanding.
TedWolf says "Furthermore, there are many studies conducted by large Medical Centers in the US and Europe (Mount Sinai, Boston Memorial, for example) on the efficacy of acupuncture and the results are outstanding."
GREAT! So you can be the first to cite the high quality evidence for acupuncture. Everyone else provides anecdote and testimonial (and irrelevant articles in inferior magazines). We expect to hear more from you, soon.