Those Who Question Scientific Basis Have Not Done Their Homework
As a former Aerospace Engineer who flight tested helicopters and performed cutting-edge research in the field of turbulent aerodynamics, I can honestly say that acupuncture is a thoroughly proven system of healthcare. Proving acupuncture efficacy is relatively easy - western medicine and modern science are having a difficult time understanding the underlying mechanisms as to how acupuncture works. As an example, a common health concern I encounter in my clinic is female infertility. Countless studies have proven acupuncture’s effectiveness in improving the viability and diameter of ova, but have not come close to explaining how it works. In a 1993 publication entitled “Clinical studies on the mechanism for acupuncture stimulation of ovulation,” a number of reproductive hormones serum levels were measured in 34 anovulatory (non-ovulating) women before and throughout an average of 30 acupuncture treatments. The total effective rate was 82.35%, and as quoted in the text, “the results also showed that acupuncture may adjust FSH, LH, and E2 in two directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result. Results showed that acupuncture may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation.” Postulation exists, but an absolute understanding of the mechanisms of acupuncture is still out of reach to the scientific community.
I’ve had physicians tell me confidently that there’s no proof to acupuncture’s physiologic effects on patients. If you type in the key word “acupuncture” into the NIH national library of medicine “PubMed” database, it will return over 13,000 peer reviewed journal articles. That doesn’t mean ALL of the articles are favorable toward acupuncture, but it demonstrates that there is a significant amount of research on the topic. Many tests were performed by MDs with minimal (approximately 200 hours) of training in acupuncture, so the corresponding results were poor.
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Yes, there are plenty of articles - and if you summarize this evidence it amounts to very little evidence indeed: There is no solid proof that acupuncture is effective beyond a placebo effect for anything other than pain and nausea.
if you have ever been in serious pain, or been seriously nauseous, how could you hold this evidence in such low esteem? I'm half joking here, but I'm also half serious. The last time I was extremely nauseous and dry heaving, I would have taken anything to feel better. This is an important point. alleviating suffering is one of the highest callings, some would say the highest.
The vast majority of medications people take are for pain management and digestive problems... hello? And yet they are not effective enough to keep people from seeking out something better, like acupuncture.
Do you have any reliable evidence that people benefit from acupuncture beyond placebo? That is the topic.
Well to be precise, the topic is whether or not acupuncture works, not, do you have any reliable evidence, with stress being on the word reliable. I understand that the gold standard for scientific knowledge is the double blind experimental study, and I venture to guess that is what you mean by reliable. The more I study acupuncture and the more I read about how it is being researched, the less sure I am that such studies will give an accurate representation of how effective acupuncture is. I'll have to see how it plays out. But for me the most reliable evidence has usually come from my own experience and that is what I'm basing my opinion on. Do you have any personal experience with acupuncture?
We did not make progress in medicine till we realized how easily we fooled ourselves with "experience." "Experience" supported scalding, bleeding, purgatives (exceedingly unpleasant, toxic medications), trepaning (drilling holes in the skull) and much more. Scientifically controlled studies (and advances in the understanding of anatomy, physiology and pharmacology) showed us that was all nonsense.
Well-done studies of acupuncture show that it is equally useless. I am underwhelmed by your claims of "experience."
You overstate the case considerably. Many major advances in modern medicine and public health occured without double blind controlled studies. Removing a handle from a pump on a London well brought cholera under control. Sugeons washing their hands before delivering babies after visiting the morgue reduced sepsis in pregnancy. All dismissed as cranks at the time.
I really was asking a question, you don't have to answer if you don't want to.
If your question is about my personal experience with acupuncture- I have an extensive database on the subject, as well as knowledge of anatomy and physiology. They all lead to the conclusion that acupuncture is no better than placebo.
As I responded to your question, above, personal anecdotes and testimonial do not demonstrate efficacy.
I'm amazed that you esteem personal experience so little. Yes, we can all be fooled from time to time by our senses but we can't stop relying on them.. Descartes said that. Personal experience is absolutely relevant, just not in the statistical frame of reference that you want to erect around this topic. It's absolutely relevant in my choice to learn about what acupuncture has to offer, and your choice to reject it. I think that you are having a hard time saying that you have never had acupuncture, and that's interesting to me. Perhaps you are thinking that there is no need for you to experience it, because you've already seen enough evidence to convince you that it is ineffectual. Reading what other people have to say about something is good, but is in no way a substitute for the actual experience. I think you would agree with me on this point at least in the abstract. I have read some studies on acupuncture that have showed efficacy and some that have not, and I have had some various personal experiences with the practice of acupuncture. Things I have read have at times made me feel doubtful, but what could I ever read that would convince me I didn't feel what I felt, or that I didn't see what I saw? This I what I mean by personal experience.
Tell me about your database.
I was just trying to explain to you why "personal experience" is unreliable. Whether I have any personal experience, beyond scholarly study, is irrelevant to the topic.
What is relevant- is whether you have reliable studies to support any of your claims. I keep asking, and you keep dodging. I think it is safe to conclude that all you have is, unreliable, testimonial and anecdote.
JJM - I agree that Snake Oil Science is an excellent book and from it (and a little common sense) we can ask for the following:
Has there ever been a double blind placebo controlled trial of acupuncture with more that 100 participants per group, a low attrition rate, controlled for natural history which tests in one group all that constitutes a treatment (time spent with accupuncturist in 'consultation', maybe massage, relaxing to soft music etc) followed by the actual acupuncture, compared to:
All of the above, including the acupuncture but where the acupuncture is performed on parts of the body that would be consistent with acupuncture but not actually on the meridians etc. specified with the condition?
I admit that this would be difficult to double blind, but it does not rely on non-penetrating needles. and it is important to remember that any errors e.g. a patient knowing they are in the placebo group will work in favor of acupuncture being true.
If anyone knows of any such trials, please post them along with a URL.
I agree with AAPrescott above. Double-blind placebo controlled studies are pointless with regard to acupuncture. If 100 different patients with the same Western medical diagnosis come for real acupuncture, they will likely get 100 different treatments, because acupuncture does not treat the narrowly-defined condition, but instead treats the whole person according to the energetic configuration presented in the present moment; persons are as individual as snowflakes, and a particular configuration today is gone tomorrow. You can't run a double-blind study that way. The research has already been done for the past 3000 years at least, and it's called experiential research. My knee quit hurting, the degeneration reversed itself, and I don't need surgery anymore. And you want to say, "Prove it!" How pointless.
The point is that acupuncture always fails rigorous studies- so, rather than admit it is useless, you wish to argue that rigorous studies don't work. Rigorous studies are proven to work, acupuncture is not.
I was replying to a previous posting and my reply got displaced in the thread. I was saying that I DID NOT say they were pointless just limited.
Actually just to clarify - I did not intend to say that they are pointless. I recognize their value. But I do see it as a very narrow application of scientific method that sometimes has problems in applicaton. There are political problems and practical problems. Heisenberg is said to have said that: "What we observe is not nature itself, but nature exposed to our method of questioning."
"but instead treats the whole person according to the energetic configuration presented in the present moment". And just how can this energy be measured or in any way independently observed?
As for people being different, of course they are but the very fact that we can label something as "acupuncture" means that we have a repeatable process that can be measured against another. Make all the treatments unique, but take the one thing that is common to them all i.e. the actual needle insertion part and make a very minor change i.e. move them from so called meridians to ransom places and see what happens. Nothing in your post suggests this can't be done and if acupuncture really worked then it would pass this test with flying colors.
If anyone replies to this, don't forget to answer the first point too!
I had worked at Columbia University School of Nursing for 5 years on 2 NIH funded research studies testing the efficacy of Acupuncture in HIV+ related disorders. It was a double blinded controlled study where patients were randomly placed in either the real or control group. The study results are being written as we speak in FAVOR of Acupuncture and Moxibustion for Diarrhea. There were 2 other studies that are not finished but I can honestly say that I saw wonderful results in the patients that were receiving the treatments, as I was not blinded in this study.
I completely agree that I think that this sort of test would be the best way to do so. To have three test groups, all unaware of which group they are in, with a measurable issue, such as hypertension, or pain awareness, or even something that limits range of motion. Have one group treated with actual needle insertion in the right points (i.e. a genuine treatment), no electro, no other added modalities. Have the second group receive what would be a "genuine treatment" as far as using the right points, but not insert needles, rather use the newly created "study" needles that do not puncture the skin. And then have the third group where needles are inserted in Non-point, off meridian locations.
That would be a good study.
Also, being that my husband has treated myself, my family, friends and children, in non-office settings, with nothing but needles. No comfy table, no soothing music, in all kinds of odd locations and under odd circumstances, and still achieved the same results. The office settings just help people be more comfortable. But even in an uncomfortable setting I personally know that the needles still work.
This is called the placebo effect.
You don't need the comfy surroundings, just a treatment, any treatment that you believe has an effect.
In trying to answer your first point someone had already mentioned the studies of Becker and electrical properties of living organisms. But waxing a little philosophical I could point out that science (consensus) is suggesting that 90%+ of energy and matter in the universe seems to be missing - we believe it is there because otherwise the equations don't work but we haven't been able to detect it. The Chinese apparently discovered, and had a more accurate measurement of the circulation of blood well before Harvey why is it hard to believe that they discovered something else that we have not caught up with yet?
Manfred Porkert has (controversialy) argued that Chinese Medicine is scientific. He suggests that quantitative measurement is easily agreed uupon. But qualitative measures present difficulty. But if there are principles (Yin/Yang, Five Phases) that are applied by different people who independently come up with consistent answers when applying those principles then those principles are scientific even though they do not lend themselves to fit a narrow definition of the scientific method.
"I could point out that science (consensus) is suggesting that 90%+ of energy and matter in the universe seems to be missing - we believe it is there because otherwise the equations don't work but we haven't been able to detect it."
What on earth (or not) has this got to do with acupuncture? Don't tell me... here is some weird form of energy we don't fully understand; and so called 'energy' in acupuncture would, if it existed, also be something we don't understand therefore one explains the other!
This ranks along with quantum mechanics being used to 'explain' all sorts of nonsense out there from being psychic to talking to the dead.
I think we can do better than this.
There is a basic difference in world view here. Chinese traditional thought is an amazing coherent system, the medicine is the application of the cosmological and philosophical system. So Qi, Yin/Yang, Five Phases describe the macrocosm and microcosm. This is mediaeval type thinking but I do not use that derogatively. Qi is the fundamental 'substance' of the universe that arises out of the void, matter is solidified Qi. Physiological Qi (the concern of medicine) is the motive force (electricity) of the living organism. You may find this preposterous, but I don't, I consider Western thought as suffereing from a bifurcation that occured in some hundreds of years ago that is referred to as the Cartesian division. The central question that divides many is: is the strange world of quantum physics something that only matters on the extremes, and our world is actually Newtonian to all intents and purposes or do the discoveries of modern physics actually have a bearing on the world we experience and perhaps begin to explain some of the anomalies that we actually experience.
I began reading your post and assumed you were writing a parody of yourself, but no, you're serious. Either way, to bring things back on topic, if any intervention, be it CAM or Western, claims to make any difference then this should be measurable, else how would the patient know that such a difference had been made? And this brings me right back to the original question asking for the results of such trials.
The changes and results of acupuncture ARE measurable, and have not only been measured in the studies that have been done so far to measure pain improvement, but are measured during treatment by the acupuncturist. The changes are in the pulses found in the wrist, as well as in the odor the person is emitting, the color of their skin, the sound of their voice, and their emotional state. I personally was skeptical about this until I saw the changes myself, and felt the pulse changes in my own wrists before and after several treatments.
Lots of anecdotal 'evidence', but where are the RCTs? - see my initial post.
Unfortunately you are correct that many of the numerous trials done in China are questionable by Western standards. The post operative nausea trial was presented in a talk by an anaesthesiologist at Duke and he certainly considered it to be stringent. One of the problems is that no one is very interested in funding studies of the scale that you would like to see. At present Chinese medicine doctoral programs that teach a about Western research methods have just been launched so I have no doubt that at some point a research will be done. However, I personaly do not need to have it proved to me so I am not going to wait.
Meanwhile another anecdote - a patient whose stress incontinence had been improving was treated with a particular point and said she had an incident of lost bladder control after treatment - when I researched the points that had been done it included a point that promoted urination. A negative is a peculiar proof of placebo effect especially when that effect contradicted what the practitoner believed at the time. Food for thought? But just an anecdote - it could have been all a big coincidence.
Below is the abstract of the study cited by Bill Reddy:
It is published in the Journal of Traditional Chinese Medicine, http://www.jtcm.com/index.html
Out of 13,000 articles, why would you choose to highlight this one?
Ovulatory dysfunction is commonly seen in gynecology clinic. It may cause infertility, amenia, functional uterine bleeding and a variety of complications. This research according to TCM theory records treating with acupuncture 34 patients suffering from ovulatory dysfunction. Changes in clinical symptoms and some relative targets are reported, plus findings in animal experiments. The effect of acupuncture in improving ovulation and the rationale are discussed. According to TCM theory concerning the generative and physiologic axis of women, this research involved the following points: Ganshu (UB 18), Shenshu (UB 23), Guanyuan (Ren 4), Zhongji (Ren 3), and Sanyinjiao (Sp 6). The reinforcement and reduction of acupuncture enables it to strengthen liver and kidney. Through the Chong and Ren channels it nourishes uterus to adjust the patient's axis function and recover ovulation. Treated on an average of 30 times, the patients' symptoms improved to varying degrees. The marked effective rate was 35.29%, the total effective rate being 82.35%. BBT, VS, CMS, and B ultrasonic picture all improved to some degree. The results also showed that acupuncture may adjust FSH, LH, and E2 in two directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result. Results showed that acupuncture may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation. The results of this research will provide some scientific basis for treating and further studying this disorder.
Mr. Hammond, about the only thing a person can determine from that abstract is that the study had to few subjects to support any conclusion. It also appears that the study was not randomized and controlled, and, therefore, unblinded (although, they don't bother to mention those things). I could go on.
R. Barker Bausell has authored an excellent book (Snake Oil Science) on what constitutes good research. He particularly focuses on acupuncture, and the fact that the best evidence shows it works no better than placebo.
If one is commited to the narrow principles of 'evidence based medicine' then you will probably never be convinced of the efficacy of traditional acupuncture. As a psychiatric nurse I know that there are many areas of orthodox medicine that can never be 100% verified by double blind placebo controlled trials.
One problem often cited is that traditional acupuncture individualizes the treatment - many of us were quite surprised at the positive results in the trial of Pericardium 6 for post operative nausea because we do not expect one point done in every case to be effective.
My point in posting that abstract was to allow the people here to see the flawed nature of the study. Bill Reddy claims that there is tremendous evidence. He should show us some of it!
The number of articles in PubMed mentioning the word acupuncture has nothing whatsoever to do with the scientific consensus on acupuncture. (There are almost as many articles containing the word "heroin," for example, but I doubt you would accept that as evidence of heroin's curative powers.) You say, "That doesn’t mean ALL of the articles are favorable toward acupuncture, but it demonstrates that there is a significant amount of research on the topic." Yes, fine, but what does the research say? That's what actually matters.
You criticize studies done by MDs with only 200 hours of training in acupuncture. I have two areas of questions about this. First, how much training would you say is sufficient? 200 hours seems like a long time -- what is it that can't be conveyed or learned in that length of training? On a related note, how much training does a typical acupuncturist have before starting a practice? Second, what portion of these tests were performed by doctors you consider insufficiently trained? How do their results compare to those obtained by MDs who you would consider adequately trained, or who used trained acupuncturists in their studies?
200 hours is enough time to learn the basics of theory and how to not hurt anyone by needling their internal organs. By contrast, California requires a minimum of 3000 ( three thousand ) hours of training, of which about 1000 are clinic hours spent observing and practicing the medicine, and then a very hard exam. That is just what's required to practice legally. A new graduate is about as good a practitioner of chinese medicine as you were good at driving right after you got your license: you probably won't get anyone killed, but you've got a long way to go before you could be called an expert.
Well said Devinv!
I absolutely disagree with MD's with only 200 hours of training being the "definitive source of judgement" on the efficacy of acupuncture. Acupuncture, like many branches of medicine, has levels and depths of knowledge, training, experience and understanding. As well as a wide variety of styles and modalities. For example there is a vast difference between simple ear & hand acupuncture, and Classical Five-Element Acupuncture. Just as there is a difference between going to a Nurse Practioner to treat a simple cold, and going to a cardiologist for heart surgery.
My husband has both a Master's Degree in Traditional Oriental Medicine from PCOM, as well as an additional full year certification from The Institute of Classical Five-Element Acupuncture, and certification from the University of Chengdu in China, and is a Dipl. OM from NCCAOM. And a Bachelor's in Psychology. This means that he has studied "medicine" for 7+ years, and specifically studied and trained in Oriental Medicine and Acupuncture for 3+ of those years. All before being sucessfully in practice. And I wouldn't even begin to consider him an "expert". Rather there are those who have even more years of education and training and practice experience that he defers to and still learns from at the Worsley Institute.
So, for MDs, or anyone else, not fully trained and educated in all of the history, foundations, theory, and practical application of Traditional Oriental Medicine, and the wide variety of styles of Acupuncture, to just take a 200 hour course and then be allowed to make definitive judgements and be considered an expert, is ludicrous.
That would be like having a Massage Therapist, pass judgement on the efficacy of a cardiology treatment.
Aurora wrote "My husband has ..."
Where is the reliable evidence that anything has or does actually works. Anecdote and testimonial do not count. Why argue? Just present the data ...
You're determined to deny anything and everything, you don't want evidence, and you already know (as I stated above) that the bias in "science" has not allowed such studies to exist yet. The only thing "medical science" studies is ways to make more $$. If there is no money to be made by Western Medicine, then there is no funding for a study, and no study happens. We in alternative medicine are working on it now, at our own expense, our own associations and groups are funding and conducting studies. Not because we need to prove to ourselves that it works, but because without the studies we can't defend ourselves against those who not too long ago were the very ones using the leeches and bleeding people's feet. I find it hilarious that the very branch of medicine most known for using "Snake oil" and superstitions, is now attacking systems time honored and proven for 5000 years.
Here are some studies, and then you can all continue on with your petty arguing, as Im certain you won't find any of these studies meet your "rigourous demands" anyway. I'm personally way to busy with our patients to continue in these discussions of discrimination any more.
There are studies on the effectiveness of acupuncture on almost everything from cancer to HIV to allergies and gynecology on this web page for anyone who would like to see for themselves, I'm not posting all of them... http://acupuncture.com/research /#1
http://acupuncture.com/newsletters/m_sept08/res.htm
Study on Effects of Different Acupuncture Manipulation Methods at Neiguan (PC 6) on Hand Spasm in Stroke Patient
Wang LC, et al. Department of Neurology, Affiliated Hospital of Integrated Chinese Medicine and Western Medicine of Hebei University of Medical Sciences, Cangzhou 061001, China. wanglichun1976@163.com
Effect of Acupuncture at Three Acupoints of Eye on Bell’s Palsy
Zhou CD, et al. Section of Rehabilitation, Guangdong Province Hospital of Integrated Chinese Medicine and Western Medicine, Foshan 528200, China. zcd401@126.com
Here is a paper too long to paste here, so here is the citation, and here is the link for anyone who wishes to view it -
http://www.liebertonline.com/doi/abs/10.1089 /acm.1996.2.79
To cite this paper:
George Thomas Lewith, Charles Vincent. The Journal of Alternative and Complementary Medicine. February 1, 1996, 2(1): 79-90. doi:10.1089/acm.1996.2.79.
Ok, I'm done here, this was a mildly amusing experience.
Aurora,
There is a hierarchy of the quality of magazines/journals that is well-established. Your citations lead to the lowest quality magazines. Long experience tells me that these publications are not worth reviewing/consulting.
The question remains- can you cite "high quality" (that is, reliable) research in scientific journals concerning humans?
What do we mean when we say "acupuncture"? Presumably, acupuncture is what you get when you go to see an acupuncturist. What are they doing? Somehow I doubt that every acupuncturist you can find in the phone book has a decade or more of training, or whatever is enough to be considered an expert in your eyes.
I have no problem with the idea that only trained experts can perform acupuncture correctly. I was asking for information about what it takes to be considered an expert. Clearly the better formulation of an experiment is not for a medical researcher to try to learn acupuncture hastily and then do it themselves, but rather to observe acupuncturists in the lab. I was asking about what proportion of studies involved hastily-trained MDs compared to the proportion that used trained acupuncturists, because calling out a small minority of poorly formulated studies in order to condemn the entirety of research on the topic is a very fallacious way of arguing.
Hi Z - while it is true that not "every acupuncturist in the phone book" has the extensive decade or more of training and experience in the US, there are still plenty of those that do have the credentials I personally consider to be requirements. The very minimum would be having passed the testing and required clinicals for status as a Diplomate of T.O.M or of Acupuncture, from the NCCAOM. I also think a minimum of a Master's Degree in Oriental Medicine is important, as well as 5 years in practice, and critical peer review, and continuing education, before one is qualified to be used as an acupuncturist in a study of the efficacy of acupuncture. But those are just my personal opinions. Also, while there are not as many who would qualify here in the US, there are thousands who do in Asia, and in Europe.
The problem has never been that there aren't enough qualified acupuncturists to conduct a study, but rather that there have not been enough studies done, and done well. Much like we know very little about Women's health compared to men's because the vast majority of studies have been done on men. Until only recently we really didn't even understand the vast differences between men and women related to the most studied illness out there - Heart Disease.
Unfortunately, the very nature of "scientific medical studies" for all their posturing, is a nature of bias and blind discrimination. Which makes it a fairly easy and comfortable position for those who disparage or deny the efficacy of alternative medicines to just sit back and say "Where's the evidence? Where's the "respectable believable data", when they all know very well that there isn't much we can point to, not because it doesn't work, but because the studies don't exist yet. And they don't exist yet because no one has had the financial incentive to do the studies. Just the opposite, Western Medicine has every reason to refute, repress, and refuse to examine in an unbiased and fair manner the benefits of alternatives that take money out of their pockets. And the "Journals" that represent that powerful Bloc, have no reason to publish or support any studies that encourage competition.
And frankly, only in recent history (very recent mostly still in progress and waiting to be published) have studies been done, and are still being done. So the body of "acceptable" evidence is new, emerging, growing, and that takes TIME. And then when the studies are published those who wish to dispute our validity will still do so, just by claiming the studies are not legitimate "enough". Meanwhile, Western Medicine will continue to do harm in the name of healing, and Pharmaceutical companies will continue to claim that their medicines are "proven in clincial studies" to be effective, only to have to recall them 5 years later, and battle class-action lawsuits against those they have harmed or killed.
Since it is only these kinds of "studies" that are considered acceptable, I would have to say this whole argument of "where's the evidence" is a total farce.
Someday these people will accept that the world is round, men landed on the moon, the earth circles the sun, and acupuncture works. Until then, we will just keep healing our patients and not really caring about the detractors who have an agenda and a closed-mind.