Everyone knows what acupuncture is! It’s about sticking needles into patients with the hope of improving their health. It is one of the oldest, most popular and most studied alternative therapies. So it has “stood the test of time” and is “flawless”… Or so many enthusiasts tell us. However, as often in the field of alternative medicine, things are not so simple. In fact, they turn out to be much more complicated.
The complexity begins with the fact that there is not one but several forms of acupuncture. Acupuncture points can allegedly be “stimulated” by inserting needles into the patient’s skin, implanting tiny devices, applying heat, electrical currents, ultrasound, pressure, bee stings, injections or light. There is also body acupuncture, ear acupuncture, scalp acupuncture and even tongue acupuncture. Some therapists use the traditional Chinese approach, while so-called “Western” acupuncturists claim to adhere to the principles of conventional medicine.
Traditional Chinese acupuncturists base their practice on the Taoist philosophy of balancing two vital forces, “yin and yang”. These are supposed to circulate in our body through channels called “meridians”. An imbalance of these forces or energies is believed to lead to disease, and acupuncture is promoted as a way to rebalance them and restore health. “Western” acupuncturists, on the other hand, tend to invoke neurophysiological theories – for example, the release of painkillers or endogenous neurotransmitters in the central nervous system – to explain how acupuncture works. Both camps have in common that their theories are more or less plausible attempts to explain the alleged benefits of acupuncture.
Hundreds of clinical studies published on acupuncture
But is it true? Does it really work? From the traditional point of view, acupuncture is effective for virtually all ailments affecting human beings. According to “Western” acupuncturists, it is especially useful for relieving chronic pain. But these are mere assumptions and we should ask ourselves where the evidence is.
Today, hundreds of clinical studies on acupuncture have been published. Medline, the largest database of medical articles, currently lists more than 40,000 articles on the subject. So it doesn’t seem hard to find evidence for even the wildest claims of acupuncturists. The whole question is to know to what extent these data turn out to be reliable. To try to answer them, it is essential to exercise critical thinking.
The majority of studies on acupuncture come from China. Several surveys have revealed that, for a whole host of reasons, we should take these trials with a grain of salt: they consistently report positive effectstheir results are often made from scratchand they are frequently generated by “item farms” completely illegal. Also, many studies on acupuncture draw unwarranted positive conclusions. based on dubious data. Therefore, the body of evidence supporting acupuncture is found to be highly unreliable.
Acupuncture, an ideal placebo
So how do you know if acupuncture is effective or not? Some would say just try and see for yourself. However, I caution you against this idea. Acupuncture has many characteristics that make it an ideal placebo: it is exotic, invasive, mildly painful, expensive, administered by an empathetic therapist, and so on. Any symptomatic improvement after acupuncture could therefore be due to a placebo response and unrelated to the therapy itself.
So what we need are properly controlled clinical trials. There are thousands of them, but the vast majority of them are very dubious. The main problem, in my opinion, is that acupuncture researchers tend to conduct clinical trials not to test whether acupuncture works, but to demonstrate that it works. This means that bias creeps into their research, whether they like it or not.
The best way to make sense of this convoluted data is to do what experts call a systematic review. This involves first locating all available studies on a particular research question, and then critically appraising them for their scientific rigour.
Acupuncture and lower back pain during pregnancy: a dubious study
Today we have many systematic reviews of acupuncture as a treatment for dozens of different conditions. The recent meta-analysis of acupuncture for low back and/or pelvic pain in pregnancy is a good example. She revealed that, based on the results of ten clinical trials, acupuncture would be effective in relieving pain and improving quality of life. Many journalists were fascinated by this discovery, and the story made headlines around the world. Almost no one heeded the many caveats: for example, many of the primary studies included in the review failed to control for placebo effects.
This story is important, not least because it shows how crucial it is to remain critical. In principle, systematic reviews represent the most reliable level of evidence we have on the effectiveness of medical interventions. But that doesn’t mean we can blindly trust them, because there are plenty of ways to cheat. Here again, critical analysis is essential.
Sometimes serious complications
The most transparent, independent and methodologically sound systematic reviews are those produced by the Cochrane Collaborative. I examined the 54 systematic reviews published by this organization, without succeeding in showing that acupuncture is effective for the treatment of a single pathology. Positive evidence has emerged only for the prevention of migraines and some headaches. More recently, an American team used a totally different approach for a global evaluation of the effectiveness of acupuncture. Their conclusions were even less favorable: “Although acupuncture has been the subject of hundreds of randomized clinical trials and systematic reviews for dozens of health conditions in adults, few conclusions presented a level of evidence higher than low.”
Acupuncture is often presented as being risk-free. Yet mild to moderate side effects of acupuncture occur in about 10% of all patients. Much more serious complications from acupuncture are also recorded. Acupuncture needles can, for example, injure vital organs like the lungs or the heart, and introduce infections into the body, such as hepatitis. A recent example is that of this British football star who had to put his career on hold because an acupuncturist had punctured his lung. Around 100 deaths after acupuncture have been reported in the medical literature – a figure which, due to the lack of a monitoring system, may only reveal the tip of the iceberg.
Since, for most diseases, there is no reliable evidence that acupuncture works, and it has been associated with significant harm, its benefits are generally not compelling compared to its risks. So I advise consumers to think twice before paying hefty sums for what is little more than a placebo.