TCS Daily

Belief, Not Medicine

By Howard Fienberg - December 31, 2002 12:00 AM

A new study in the December issue of Contemporary Pediatrics recommends the use of acupuncture to treat children with chronic pain or nausea, claiming to have evaluated the effectiveness of acupuncture for children by examining its use in adults. However, the flaws in the research reflect ongoing problems in other acupuncture studies.

All the authors in the latest study did was summarize the results of the last three decades of adult acupuncture research, highlighting possible implications for children, combined with a few of their own case studies of acupuncture treatment in children. They concluded that acupuncture was a useful "adjunctive therapy," meaning it was useful when combined with other treatments. However, they only recommended it for patients with "values and world views consistent with acupuncture." This admission handily illustrates what years of research has shown acupuncture is a matter of belief, not medicine.

For example, a study in the August 2000 Archives of Internal Medicine (AIM) presented evidence that acupuncture blunts cravings among cocaine addicts. Researchers divided addicts into three groups. One group received aural acupuncture, another got sham acupuncture and the third group was given only relaxation therapy. At the end of the trial, 53.8 percent of the acupuncture group tested cocaine-free, as opposed to 23.5 percent of the sham group and 9.1 percent of the relaxation group. But the deficiencies in the study went unnoticed. News coverage failed to highlight the limited time frame for the study (eight weeks), an important factor when considering the long-term difficulties in beating cocaine addiction. Media reports also neglected the dropout rates for the study, which were highest in the acupuncture group 54 percent, compared to 37 percent in the sham acupuncture group and only 19 percent in the relaxation group. Whether or not the dropouts were still on cocaine, we can only guess, but it certainly undercut the veracity of the conclusions. The study authors admitted within their paper that their results could not discount the placebo effect in acupuncture's efficacy.

Further discrediting the AIM study, the same authors reported on a much larger version of their trial (602 subjects, as opposed to 82 in the original) in the January 2, 2002 Journal of the American Medical Association (JAMA), which found exactly opposite results: No difference whatsoever between the acupuncture, sham and relaxation groups.

Another study, in the December 7, 2000 JAMA, showed measurable benefits in women experiencing nausea from chemotherapy. It tested electro-acupuncture (the addition of small, short electric shocks to traditional acupuncture needling) on breast cancer patients receiving chemotherapy. It found that patients receiving anti-nausea drugs alone suffered from more vomiting than those that received sham acupuncture in addition. This is an obvious indicator of the placebo effect, but those that received the electro-acupuncture vomited even less often. A U.S. News & World Report reporter interpreted this as "a real physical benefit," which might have been the case, but the study authors noted that the anti-nausea drug treatment used in their study did not include "corticosteroids or serotonin antagonists" whose use "has been shown to be superior to the agents used in this study" for controlling nausea. How that impacted the study is hard to measure, but it can't have helped.

Going for the Gold

Making a clinical trial double, part of the gold standard in medical evidence, requires both the testers and patients to be unaware of who is receiving what treatment. This was not the case for either of the aforementioned studies in 2000 and 2001. The authors of the AIM study stressed that "procedures, unlike pharmacotherapies, are nearly impossible to evaluate" under double-blind conditions. An acupuncturist must know where to put his needles, so he cannot be blinded in a trial between sham and "real" acupuncture. In addition, any patient and tester can tell the difference between listening to music in a relaxing setting and having needles jabbed into one's body or between being jabbed and being jabbed with electricity added.

The inability to conduct double blind trials is not the only hurdle between acupuncture and scientific evidence. Acupuncture revolves around a mysterious spiritual energy called chi (or qi), which supposedly traverses the body along channels called meridians. By inserting needles into special points in the body, acupuncturists believe they can control the flow of chi through the meridians and thus the organs and functions of the body. Different practitioners have different opinions on how many places you can prick, and which place controls what function. Of course, there is no way to resolve these kind of disputes. Acupuncture has no basis in anatomy because it predates modern physiology by several thousand years. Chi and its related concepts cannot be measured.

This incoherency was demonstrated in a study in the 2001 Southern Medical Journal. A woman with chronic back pain visited seven acupuncture practitioners over a two-week period. Six of the practitioners in the study diagnosed her with "Qi stagnation," 5 of them said she has "blood stagnation," 2 said she had "kidney Qi deficiency," 1 told her she had "yin deficiency," and 1 diagnosed her with "liver Qi deficiency." The treatments proposed were even more variable: of the 28 acupuncture points selected for treatment, only 4 (14 percent) were prescribed by more than one practitioner.

The study seems to have been well designed. All the practitioners had been trained at similar schools. Six potential practitioners were excluded from the test for using "highly atypical procedures," and three others because they had been practicing for less than 3 years. The study's authors farcically explain that the diagnostic findings expressed "considerable consistency" because nearly all of the practitioners found Qi or blood stagnation. As pointed out by Dr. Stephen Barrett of Quackwatch, "the most likely explanation is that these are diagnosed in nearly everyone. It would be fascinating to see what would happen if a healthy person was examined by multiple acupuncturists."

Acupuncture might be effective for a limited set of uses, but research to date has provided no reliable evidence and it is not clear how efficacy can ever be reliably proven. The lead author of the child acupuncture study used the occasion to lament the lack of insurance companies who cover acupuncture and to advocate for more money, more education and more research. But how much more time and effort should be expended for a therapy that, at best, may only be moderately useful as an addition to scientific treatments that we know work?

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