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Acupuncture Controversy

September 8, 2010 Written by JP       [Font too small?]

A rather confrontational question was recently posed to me by a guest at a dinner party. The exchange itself was relatively brief so I didn’t get the chance to learn much about the inquisitor. But I suspect that he had at least some training in the conventional medical field. He wondered how in the world I could be supportive of unconventional practices such as acupuncture and guided imagery when there are countless medications that can produce similar effects in a more predictable manner. This “gentleman” went on to list a few of his favorite examples. My response was that many holistic practices tend to encourage the body to augment its own production of biochemicals rather than introducing foreign chemicals to accomplish a comparable end.

I believe that the eastern concepts that underlie acupuncture will never be fully accepted by western medicine. The two schools of thought are simply too far apart to ever converge. However, something very positive may come about because of this profound difference in philosophy. Specifically, modern science is now investigating why acupuncture appears to possess some degree of therapeutic potential. What they’re learning will almost certainly benefit everyone on the treatment end of an acupuncture needle. (1,2,3,4,5)

Several studies of late provide compelling evidence that acupuncture can be a primary therapy or valuable adjunct for a number of health conditions. I’ve specifically selected controlled trials involving human participants to include in today’s column. This variety of research can play a major role in easing the concerns of many earnest skeptics.

  • The September 2010 issue of the peer-reviewed, medical journal, Acupuncture in Medicine offers hope to acne patients of all ages. A randomized, double-blind study involving 36 volunteers with acne found that 12 sessions of “ah shi point acupuncture” significantly reduced “inflammatory acne lesion counts” and improved quality of life. (6)
  • A trial appearing in the August edition of the Journal of Alternative and Complementary Medicine reports that placing needles in select acupoints (ST 36; ST 36 plus PC 6) is capable of improving endothelial dysfunction in patients with high blood pressure. It’s important to note that not all acupoints demonstrated such benefits. The PC6 point and placebo points were found to be ineffective. (7)
  • New research from the Universidade Federal de São Paulo, Brazil reveals that a single session of electroacupuncture or manual acupuncture can successfully improve symptoms of sleep apnea. Objective measures of sleep quality known collectively as the Apnea-Hypopnea Index and polysomnography improved only in patients receiving acupuncture. A placebo or “no treatment group” was used as a comparison model. The conclusion of the trial points out that the number of “nocturnal respiratory events” also declined in the treatment groups. (8)
Manual (MA) and Electroacupuncture (EA) May Improve Sleep Apnea Symptoms
Source: Acupunct Med 2010;28:115-119 (link)

The two remaining studies applied an integrative treatment model. The first, which is presented in the August 2010 issue of the Journal of Affective Disorders, examined the potential of acupuncture as an adjunct to antidepressant treatment in “non-responsive” patients with major depressive disorder. A total of 30 volunteers who did not respond to conventional care were enrolled in the experiment. A depression index referred to as the Hamilton-D 17 scale was used to assess any change in depressive symptoms. The researchers documented an average 47% response rate to the combined therapies. The acupuncture was found to be “safe, well tolerated and effective in antidepressant partial and non-responders, suggesting good feasibility in outpatient settings”. (9)

The final trial aimed to determine whether acupuncture could provide additional pain relief to patients receiving conventional care for endometriosis. A group of 101 women was treated with “verum” (real) or sham acupuncture over a 5 week period. Acupuncture was administered twice weekly during the intervention. After the completion of the research, the women were observed for at least two menstrual cycles. A “10-point visual analogue scale” was employed at baseline and at the completion of each stage of this randomized, crossover study. The volunteers given the real acupuncture “showed a significant reduction in pain intensity”. (10)

As with any form of medical therapy, it’s important to find a reputable source of care. The safety and success of acupuncture rests heavily on the skill of the practitioner applying the needles. What’s more, even the most competent acupuncturists can’t completely rule out the possibility of occasional side effects. A recent review of 3,071 acupuncture treatment sessions found a total of 99 adverse events or 3.2 cases per 100 treatments. The majority was related to mild bleeding and none were deemed “serious adverse events”. The closing remark of the review assures prospective patients and referring physicians that, “If acupuncture treatment is administered by a practitioner with enough experience and is conducted in accordance with established guideline, it is a safe treatment method”. That’s reassuring to know. But it also places the responsibility of finding such a healer squarely in your hands. Please do so carefully if you decide to use acupuncture in your wellness regimen. (11)

Be well!

JP

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10 Comments to “Acupuncture Controversy”

  1. CW Says:

    I think I’m going to play the contrarian here, JP.

    Just to touch on the skeptic part of the issue. I think the skeptical position regarding acupuncture is two-fold: (1)The things called meridians (which are the points on a body where needles are targeting) have never been proven, nor do they relate to what we know about human physiology; and (2)There is a great deal of disparity amongst acupuncture philosophy and practices (such as disagreement on locations of meridian points, techniques, etc.).

    As far as my understanding on the topic has shown, when acupuncture is used in a double-blinded, controlled study with a significant sample size – it’s treatment fares no better than placebo.

    Let’s look at the acne study. 36 people is hardly a good sample size. However, according to the abstract, can you really call this a “controlled study?” There were two groups (standard acupuncture and “ah shi”/standard acupuncture). As far as I can tell, this was testing the difference between the efficacy of two types of acupuncture – not in acupuncture itself. A better study would have had one group receiving the standard acupuncture treatment, another group receiving ah-shi acupuncture, a third group receiving sham acupuncture (placebo), and a fourth receiving no treatment. I just don’t think this study holds up very well because there was no control that accounted for placebo and treatment efficacy itself.

    The second study, hypertension, has only 15 people. Again, not a good sample size at all. This appears to be a simple pilot study. And even the conclusion of the study suggests as much.

    I’d like to point out that the majority of acupuncture studies are typically done in Asian countries. While this does not mean anything by itself, I mention it because it’s possible that cultural biases do play a minor role here. When studies are replicated in Western cultures, the results are not. It’s not to say that fraud is being perpetuated, but rather it could be that cultural influences could create a somewhat stronger placebo effect in subjects.

    On to the third study, this is interesting because they were testing acupuncture and electro-acupuncture (surely the traditions of acupuncture did not incorporate electricity). Again, small sample size of 40.

    The last two studies both are treating more subjective ailments. Both were lacking sufficient controls. And in the last study, even its own conclusion admitted that the sample size was small. Also it was studying its treatment on depression, but still allowed anti-depressant drugs. So it’s really hard to gauge anything, in my opinion.

    To sum up, at best, it seems to me that acupuncture possibly has some efficacy on subjective ailments (back pain, depression, etc.) which could be partially placebo, and also because there is a physiological process working during the treatment. When you puncture the skin, its natural healing processes go to work and the pain receptors are inhibited. It’s very plausible that a patient would feel better under those circumstances. But does it help in the long term? I think acupuncture has yet to have any sustained efficacy. And in the short-term, it seems to be lacking any significant evidence that it works.

  2. JP Says:

    Thank you, Chris! I really appreciate your detailed comments!

    I agree with the first points you make re: the meridians and the disparity of techniques.

    I think the argument about sample size is more problematic. I’d bet dollars to donuts that most of the researchers involved would prefer to have 500 or more test subjects but lack the funding. By employing randomized, blinded and crossover designs they’re doing the best they can with what they’ve got.

    re: acne study

    Agreed. The study format could have been better. I wish they would have consulted with us first. :)

    re: hypertension study

    I don’t disagree. Nonetheless, the results of pilot studies have merit. I’d love to see a larger study using a similar format – which was quite solid,IMO. Let’s hope someone funds it.

    As I stated in the piece, I’m all for the scientific evaluation of how and why acupuncture works (in some cases). If it turns out to be something as simple as the physiological consequences of puncturing the skin … so be it. However, this doesn’t appear to the case. My first set of footnotes attest to this fact and I could have included many more.

    As a side note, if a placebo can be consistently and successfully applied, I’m all for it. Especially if it has a better safety record than conventional treatments with questionable success rates. Antidepressant medications come to mind. I would much rather that the brain heal the body then to introduce a newly manufactured chemical substance into the body with unknown long-term effects.

    I hope the tone of my reply comes across as being constructive. That’s certainly how I intended it. I sincerely value your thoughtful comments.

    Be well!

    JP

  3. CW Says:

    JP,

    Thank you. I don’t think your tone was hostile in anyway, I hope mine wasn’t either.

    While it is true that many scientists would like to have the funding to administrate studies with large sample sizes, it is still important to point out why low sample sizes is problematic. The smaller the study sample size, the more noise in the data. And proponents of pseudoscience have made many claims based on noise. This is particularly true in parapsychology studies.

    Depending on the size and scope of study, the placebo effect can range from 10% to 35%. Typically, the more subjective the symptoms being treated, the higher the placebo effect. This is particularly true in studies on mood/behavior.

    I understand your hesitancy towards antidepressant medication. I share some of those concerns. I believe that mood-modifying drugs is over-prescribed.

    However, I am reluctant to agree with you regarding endorsing placebo as a viable treatment option. While it’s true that placebo is a safe alternative to more invasive treatments, I would not want to endorse placebo as a treatment itself because sometimes subjective symptoms do have an underlying physiological cause.

    Symptoms for subjective ailments (like depression) can be similar to symptoms for a disease (such as Encephalitis), and no rational person would ever suggest that acupuncture or placebo can cure a disease.

    And while it’s possible that a patient may have a non-life threatening condition, where placebo or acupuncture, could be used harmlessly – I would argue that it’s never 100% certain that a non-life threatening diagnosis can be determined.

  4. JP Says:

    Chris,

    Your tone most certainly is not hostile. :)

    Let me provide a practical example of how I think a possible/suspected placebo can be used to good effect:

    A patient walks into an allopathic doctor’s office. (S)He has fibromyalgia. (S)He presents a print out of several studies showing that alternative therapies may be helpful in controlling said symptoms.

    What does the doctor have to offer? Medications? Sure. But like most medications, they primarily manage symptoms. They’re not curative. Then there’s the very real possibility of adverse reactions, drug interactions and the like.

    Now let’s assume this physician is skeptical of holistic practices. (S)He looks over the print out and thinks many of the same thoughts you’ve mentioned – imperfect study designs, potential of cultural bias, small studies, etc.

    What should (s)he do? In my opinion (s)he should work with the patient to establish *if* the alternative therapy works for them in a safe manner. Rather than discourage them and pressure them to take a non-curative drug with the potential for harm … (s)he should help them to objectively and subjectively determine if the alternative is safe and viable. Call it a test case.

    To me, that’s a good middle-ground.

    To be clear, I always think it’s a wise decision to seek out a diagnosis from a medical professional. However, I don’t see how using a drug or surgery to treat a mistakenly diagnosed condition yields any additional benefits over an alternative remedy. This is especially true if allopathic physicians would be more willing to work with patients who wish to utilize alternatives while under the supervision of an allopath.

    Again, a good middle-ground, IMO.

    Be well!

    JP

  5. Comeback Geezer Says:

    I was a skeptic and acupuncture cured my severe asthma.
    It also cured shingles for my mother and 2 sisters.

  6. CW Says:

    Fibromyalgia is a good example, and I would agree. It’s a relatively new ailment – and has yet to be completely figured out. I think looking at alternative treatments would be an option worth considering, especially since a common symptom correlated with it is lack of sleep – and there are many lifestyle and/or natural ways of handling poor sleep.

  7. Sue Says:

    Have you read this on accupuncture, very interesting:
    http://thehealthyskeptic.org/acupuncture

  8. JP Says:

    Thank you, Sue. I’ll check it out. :)

    Be well!

    JP

  9. liverock Says:

    JP

    All this reminds me of how accupuncture first got started……

    http://www.funny-city.com/cartoons/acupuncture.shtml

  10. JP Says:

    Ha! Very funny! :)

    Be well!

    JP

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