Acupuncture doesn’t work, although it may help…
Wait, what? How can something that doesn’t work, help? And if it helps, doesn’t that mean it works?
There is a new study out today (Reuters, Seattle PI) from the Group Health Center for Health Studies that shows acupuncture provides at least some benefit to people with chronic lower back pain. I’m sure that acupuncture devotees will latch onto this study as meaningful proof that acupuncture works, but they should pause before popping the champagne cork: the study also demonstrated that it didn’t matter if you used needles or toothpicks, or whether you penetrated or didn’t penetrate the skin. Although this study didn’t run a test group that received acupuncture using non-acupuncture points (it would have been more thorough if it had, and I wonder why it did not), the results match other studies that have done exactly that, so it’s safe to say that acupuncture works whether you’re receiving “real” acupuncture or not. The mere act of poking someone in the back with something sharp (maybe not even that; other studies have shown that fingertips will do) and telling them they were being treated with acupuncture was good enough to realize the same amount of benefit across the board. The conclusion of the study was this:
Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects.
As the conclusion suggests, what we’re probably seeing here is the famed placebo effect at work – if someone genuinely believes that a sham treatment will work, sometimes it does. Whatever the real reason, the study makes it clear that the mechanism of action – why does acupuncture work? – remains a mystery. Traditional Chinese medicine claims that acupuncture releases qi energy, but such energy has never actually been observed and is not scientifically recognized.
So, even if acupuncture is chiefly a matter of belief, what’s the harm if it provides relief? It may be fair to say that, for some, acupuncture helps. But it most likely doesn’t “work”, meaning that there is no mechanism by which acupuncture itself treats anything. The suggestion that it will treat something and the strong beliefs of many of its patients probably contributes greatly to its anecdotal success, but it is important to note that the placebo effect is not a miracle worker. It won’t make a tumor go away just because a patient believes it will. And this is where the danger lies – people tend to attribute far too much power to the placebo effect, thinking that it doesn’t matter if the treatment works or not as long as it helps. If you merely feel pain, yes, a placebo treatment may help, probably because a great deal of pain is in the mind and a matter of perspective and attitude. But if you have a condition such as cancer or a viral infection or what have you, the placebo effect isn’t going to do anything, and believing otherwise is likely to cause harm. Tumors don’t have beliefs and are not affected by placebos.
The whole study can be found here. It’s pretty accessible to the layman and well worth a read, especially the discussion at the end.
May 11th, 2009 at 9:06 pm
I like your entry. It seems to reflect the central argument in the book _Snake Oil Science_.
“But if you have a condition such as cancer or a viral infection or what have you, the placebo effect isn’t going to do anything, and believing otherwise is likely to cause harm. Tumors don’t have beliefs and are not affected by placebos.”
Doesn’t the very existence of the placebo effect suggest a strong mind-body connection that you, in the excerpt, seem to be discounting?
Further, there’s significant evidence out there that medical treatment has a likelihood to cause harm. Suggesting that an acupuncture can do harm may be accurate but HOW MUCH harm relative to an oncologist or infectious disease specialist?
May 11th, 2009 at 9:41 pm
Hi, thanks for the comment. I haven’t read “Snake Oil Science” yet, but I have it on my “to read” list.
I don’t discount the mind-body connection at all, and I don’t mean to suggest there isn’t one. What I intended with my argument was to point out that the placebo effect isn’t a cure-all, which in urban legend it’s often portrayed as being. It helps most often when someone is experiencing some kind of discomfort or pain sensation. However, many studies have shown that if you have an actual physiological condition, such as cancer or a viral infection, the placebo effect doesn’t apply. This is because while there is a definite mind-body connection when it comes to your perception of pain, there is no mind-body connection when a third agent is involved, such as a tumor or a virus, simply because outside agents like tumors and viruses are not vulnerable to any kind of belief system, even yours. Belief in a healing agent, no matter how powerful, can’t shrink a tumor.
As to harm caused by standard medicine, sure. Doctors are people and make mistakes, and medicine is not perfect. We do our best, but it’s not exactly a “hard” science like physics or mathematics. We’re dealing with biology, and we’re really in our infancy in studying both biology and medicine, and we have a long way to go. But there’s a difference between treatments that have clinical veracity and those that do not. All alternative medicine really is, is unproven medicine. Once it’s studied, it either becomes proven or discounted, and is no longer alternative. I don’t reject alternative medicine, rather I call for it to be studied and either verified or dismissed. The only reason I mention harm with regards to acupuncture is because acupuncture is well-studied and we know its limits pretty well, and if someone tries to use it to treat a serious disease caused by an outside agent, such as the aforementioned cancer or viral infection, it’s going to fail. In such cases, people should seek more proven treatments. Though they may not work either, they stand a better chance.
Your final question is a good one, though, so please don’t think I’m discounting your statement. You make a good point: it is important to ask how much harm compared to other treatments. This is a question that should be asked of all treatments, in order to try and select the best ones for a particular case.
Thanks again for the comment, I really like the back and forth dialogue and I think such discussions are useful for all involved.