Ancient Technique Walks on Pins and Needles
by Howard Fienberg
According to a December 18 U.S. News & World Report headline, Acupuncture Can Work, and Its Not Just Wishful Thinking. While most doctors remain deeply skeptical, saying theres little scientific evidence of acupunctures workings or effectiveness, U.S. News says that might be changing, thanks to two recent studies.
One study, published back in August in the Archives of Internal Medicine (AIM) (Aug. 14/28), presented evidence that acupuncture blunts cravings among cocaine addicts. Another study in the Journal of the American Medical Association (JAMA) (Dec. 7) showed measurable benefits in women nauseated from chemotherapy. Unfortunately, neither study provides much evidence of acupunctures efficacy.
The Associated Press headline on the AIM study was typical: Acupuncture May Help Cocaine Addicts, Researchers Find (Aug. 14). 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 raises questions about the conclusions. The study authors admit within their paper that their results cannot discount the placebo effect in acupunctures efficacy.
The second study cited by U.S. News, from JAMA, received no noticeable press coverage elsewhere. 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. U.S. News admits this is an obvious indicator of the placebo effect. However, those that received the electro-acupuncture vomited even less often, which U.S. News said implied a real physical benefit.
Possibly, but the study authors noted in their article 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. It is unclear how the use of sub-par drug treatment might have affected the study.
Making a clinical trial double-blind, 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 the AIM or the JAMA studies. The authors of the AIM study stress 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 ones 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.
U.S. News relied on two suggestive but hardly conclusive pieces of research. Acupuncture might be effective for a limited set of uses, but research to date has provided no reliable evidence and how efficacy will ever be reliably proven is unclear. The magazine at least concluded cautiously, with a quote from psychiatrist Michael Smith: as a magic bullet... acupuncture is not much good.
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