AS I write, New Year’s Day is in recent memory and Chinese New Year is upon us, so thoughts of the new – and of the old – come to mind.

I’ve just been rereading an article about so-called traditional Chinese medicine (TCM), acupuncture, what’s really old, and what’s new.

It is well established that what we call TCM – often lauded as ancient wisdom – is neither traditional nor ancient. It is thought that ancient references to “needling” were describing methods of lancing lesions, such as abscesses, or blood-letting – not the insertion of ultrathin needles, which could not have been manufactured with the technology of the time.

In fact, TCM was a reinvention by Chairman Mao, who, himself, respected scientific medicine. As part of the Cultural Revolution, and facing the health care needs of an astronomical population, the so-called “TCM” was born. These two articles (here and here), detailing evidence for these developments, are fascinating to read.

The so-called “West” – largely the anglophone world – became fascinated with “ancient Chinese wisdom”, paradoxically, during a time that the major advances in conventional medicine – antibiotics, surgical techniques and vaccines – had already occurred.

This reaction against the so-called “reductionism” of the clinical sciences may be seen as a backlash against what was being perceived as a loss of mystery – or mysticism – which also accompanied a turn away from traditional religion. It also coincided with Nixon’s visit to Beijing in the 1970s.

Meanwhile, China survived Mao’s regime and began to build up enormous knowledge and technology in science-based medicine, and still leads the world in fields such as cardiology and the surgical specialties. This reflects a very important point: there is no “Eastern” or “Western” medicine, there are therapies that are scientifically plausible, effective and acceptably safe (aka medicine), and those which are not.

It has previously been argued here that registration of TCM practitioners by the Australian Health Practitioner Regulation Agency, although useful for regulation and oversight, risks lending a professional legitimacy equivalent to conventional medicine.

Of further interest to me, though, is the incorporation of acupuncture within conventional medical practice.

Australian medical practitioners are well versed in the clinical sciences. We know that there is no evidence for “meridians”, nor for the “humours” postulated by Hippocrates, nor for the “like treats like” model of Hahnemann, and nor for chiropractic “subluxations”. We understand the placebo mechanism and we test new therapeutic substances against it.

So, my question is this: is acupuncture the last bastion of acceptable placebo use in Australian medicine?

Dr Sue Ieraci is a specialist emergency physician with 30 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She is an executive member of Friends of Science in Medicine.

 

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35 thoughts on “Nothing “traditional” about acupuncture

  1. Anonymous says:

    Disagree with a professional sport whose main am is to produce a closed head injury. There is a case to use the some of the technique of boxing however is the teaching of self defence.

  2. Dr Ian Relf, Australian Medical Acupuncture College says:

    Clearly the author has not read the science of acupuncture; which is a shame for such an otherwise highly respectable medical professional.
    I would be happy to take her through the well established Level 1 evidence. It also includes significant reductions in mortality rates and health costs.

  3. John Quintner says:

    Dr Ieraci, there is another related bastion to be stormed – the practice of inserting needles into so-called myofascial trigger points.

    This is a popular and lucrative treatment modality employed by physical therapists of all persuasions.

    However, the theory behind such “dry needling” has been exposed as conjecture.

    I have attached a useful link to the heated debate on the topic that took place just over 2 years ago: http://www.bodyinmind.org/trigger-point-evaluation/

  4. Sue Ieraci says:

    On the contrary, Dr Relf – the author has read extensively in the area, and has based her comments on rigorous evidence reviews.

    If Dr Relf would like to post some references, I would be more than happy to discuss them.

  5. Anonymous says:

    It is disappointing to see the public deceived by a series of fake treatments, although some say there is evidence of effectiveness of acupuncture in pain control. Resolution of uncertainty about such touted remedies can presumably only come about by research. The internet has become a dubious force because people believe any thing they read there- even against advice. I find my own family accept internet and social network recommendations even without evidence, despite advice from 45 years of medical practice. C’ est la vie!

  6. Sue Ieraci says:

    Thank you, Dr Quinter – I agree that ”dry needling” represents yet another elaborate placebo. Unfortunately, physical therapy providers who work purely in private practice can become removed from evidence-based care.

    The anonymous commenter is correct about evidence, and the dubious information available on-line. For that reason, it is important that medical practitioners become familiar with the good quality evidence, as outlined in the references and links in the article. We are in a good position to educate others in this area.

  7. Anonymous says:

    Sue, were you time poor when you wrote this poorly assembled article? Very unlike your usual articles which are well thought out and have several references.

  8. Sue Ieraci says:

    No, anonymous commenter – there are several excellent references linked in the text. Is there a particular point you would like to discuss?

  9. John McDonald says:

    As of today there are 8,562 clinical trials of acupuncture listed in the Cochrane database, but only 5,575 for physiotherapy and yet I hear no complaints about physiotherapy being placebo. Large robust clinical trials have shown acupuncture to be superior to placebo. Hundreds of studies have also demonstrated the underlying physiological mechanisms of acupuncture especially regarding analgesic and anti-inflammatory effects. The placebo hypothesis has been soundly refuted. As for any imputation that acupuncture is somehow a recent invention of the Maoist era the acupuncture literature, which is extensive, is continuous from years BC to now. Does the effectiveness of acupuncture rest on whether or not “meridians” have an anatomical substrate? No, of course not. Traditional medical theoretical constructs, which have been evolving continually and continue to do so, may be useful, or not. However this is irrelevant to whether or not acupuncture is an effective therapy.

  10. Joel Hamm says:

    I feel compelled to disrupt the echo-chamber.

    When I read articles like this, it’s plain to see why a science based observer would be apalled by the apparent lack of evidence to support a medical practice like TCM. TCM is full of inaccuracies, and it is rooted in Taoist philosophy. Words like Wind, cold damp to serve as an explanation of arthritis sounds silly to a purely scientific mind and cannot be respected based on that alone. So your scepticism is triggered, but mingled with derision.

    The first article does an adequate job of calling to light the numerous movements that brought TCM to be during the cultural revolution. It calls into question poor historical practice of acupuncture oblivious to sensitive organs below, causing further injury and death. Scare tactic. It questions the motivations of Mao’s promotion of TCM. It questions historical practice from thousands of years ago, likening it to magic and spirit. Wrong.

    The Neijing, the first printed medical text in human history, goes to great lengths to dispell the myth that spirits cause disease. This was more than 2000 years ago.

    I can go on discrediting the main source of this commentary, but that would take more time that I have at present. The long and short if it is simply derisive, calling into question all the worst possible exampes in order to support a foregone conclusion, and it become fear-mongering.

    TCM herbs have potential to heal, but is rife with problems with production and cleanliness due to crippling corruption in China. But there are sources that can be trusted. The practice of herbal formulation carries risk of dangerous interaction with prescribed pharmaceuticals. But this does not make it a waste of time for further study.

    Acupuncture is not barbaric because 70 years ago there was a terrible acupuncturist who had no idea about AnP. Today, acupuncturists are excellent anatomists, out of necessity, and understand better the limitations of our scope of practice as integrated in the broader system.

    The author of this source did a lot of reading into the language of TCM without the attempt to understand it. He also takes snippets of recent Chinese history, to prove that it is not respected. Anyone versed in even a post graduate simester of Chinese history understands the ridiculous fallacy here. The Cultural Revolution was a period that resulted after almost a century of war and pillaging from the west. This was not a high mark of Chinese history.

    Finally, discrediting the effect of acupuncture based on the gold standard of scientific method demands a placebo. Time and time again, objectors point to the ‘fact’ that acupuncture doesn’t outperform placebo, all the while neglecting to mention that a placebo in acupuncture doesn’t not exist. Nor does it significantly outperform sham needling. Again, where is the inert control?

  11. Dr Selina Lim, FRACGP says:

    WHO official position

    Diseases, symptoms or conditions for which acupuncture has been proved – through controlled trials—to be an effective treatment:

    Adverse reactions to radiotherapy and/or chemotherapy
    Allergic rhinitis (including hay fever)
    Biliary colic
    Depression (including depressive neurosis and depression following stroke)
    Dysentery, acute bacillary
    Dysmenorrhoea, primary
    Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
    Facial pain (including craniomandibular disorders)
    Headache
    Hypertension, essential
    Hypotension, primary
    Induction of labour
    Knee pain
    Leukopenia
    Low back pain
    Malposition of fetus, correction of
    Morning sickness
    Nausea and vomiting
    Neck pain
    Pain in dentistry (including dental pain and temporomandibular dysfunction)
    Periarthritis of shoulder
    Postoperative pain
    Renal colic
    Rheumatoid arthritis
    Sciatica
    Sprain
    Stroke
    Tennis elbow

    http://www.evidencebasedacupuncture.org/who-official-position/

  12. Sue Ieraci says:

    Thanks to those who have commented – the responses provide a good basis for reviewing the evidence. Here is a pertinent extract from a 2006 paper in Clinical Medicine:
    ”Systematic reviews of acupuncture have tended to support its use, but few applied rigorous inclusion criteria. We tested the credibility of conclusions of systematic reviews of acupuncture published since 1996 by applying rigorous inclusion criteria. Reinterpretation used randomised and double blind trials with valid outcomes or design, and with information available from at least four trials or from 200 patients. Qualified support for acupuncture was originally reported in 12 out of 35 systematic reviews, and strong support was found in another six. Applying stricter inclusion criteria, however, showed that none of the 35 reviews supported acupuncture, predominantly because there were too few patients in the randomised, double blind studies. Six reviews with more than 200 patients in randomised, double blind studies had good evidence of no benefit. Systematic reviews of acupuncture have overstated effectiveness by including studies likely to be biased. They provide no robust evidence that acupuncture works for any indication.”

  13. Dr Lucy van Baalen (B. Med, FRACGP, FAMAC) says:

    Hmm – there is no placebo for surgery and surgery is still recommended as a valid intervention in acute surgical conditions! In fact when “placebo” arthroscopes were performed in knee OA, the patients who had arthroscopic debridement of the knee did worse then just a snick on the knee.

    If you bother to review the literature yourself, and looking at the original studies, instead of requoting the comments of Cochrane reviews that haven’t been updated for years, you would actually find that true acupuncture is better than standard treatment for many pain conditions, and better than placebo acupuncture (a smaller difference) if the study is large enough.

    This is what was done in the Vickers meta-analysis. Acupuncture for chronic pain: individual patient data meta-analysis. Arch Intern Med. 2012 Oct 22; 172(19): 1444–1453.
    https://www.ncbi.nlm.nih.gov/pubmed/22965186

    Vickers et al only had a rigorous inclusion criteria, and excluded all the crap studies. He looked at the raw individual data of the studies, not just relying on the conclusions of the studies.
    Bottom line results: In the analysis of 17922 patients: Acupuncture was superior to both sham and no-acupuncture control for chronic neck pain & back pain, knee OA, and headaches. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs.

    If you know anything about stats, you would know that these effect sizes are medium for no-acupuncture controls & small (but significant) for acupuncture vs sham.
    So if you want to dismiss acupuncture on the basis of evidence – please read this meta-analysis in detail and tell me why the massive Vickers meta-analysis doesn’t count as evidence, while republishing smaller older less rigorous Cochrane reviews is considered good science.

  14. JC Smith, MA, DC says:

    The author writes: “This reflects a very important point: there is no “Eastern” or “Western” medicine, there are therapies that are scientifically plausible, effective and acceptably safe (aka medicine), and those which are not.”

    This is rubbish according to the British Medical Journal. In 2013 the BMJ published on its website, Clinical Evidence, an article suggesting 2,000 of 3,000 medical treatments were ineffective, unproven or too dangerous to use.
    Once again, your group of Skeptics seem blinded and become mute when their own methods are indicted by the prestigious British Medical Journal.

    I also did not hear the author warned the public in 2016 when the BMJ revealed medical care is the third-leading cause of death in the United States (and undoubtedly in Australia) in the range of 251,000 victims per year (that the authors admit is a conservative estimate), which equates to nearly 700 deaths per day due to medical mistakes by physicians or hospital staff members.

    Instead of medical haters condemning CAM, why not let the free market place decide? If acupuncture doesn’t work, then it will disappear.

    Indeed, who put these medical Skeptics in charge, anyway? They seem like Donald Trump very eager to condemn without any supportive facts other than medical “fake news.”

  15. Joel Hamm says:

    Sue, If you could explain how a double blind clinical trial is applicable, I would much like to hear it. To exclude a valid trial based in an impossible ideal is like throwing the baby out with the bath water.

  16. Dr Igor Simonov says:

    Article says ““needling” were describing methods of lancing lesions, such as abscesses, or blood-letting – not the insertion of ultrathin needles, which could not have been manufactured with the technology of the time.” Actually Acupuncture needles were recovered from tombs of 200 BC, these needles are similar to filiform needles. Metallurgy of China already during Shang Dynasty separated silver and gold. Chinese were able in Shang period pull one once of silver into thinnest hundred meter wire to produce combs and jewelry and needles. It is BC, there are excavations and documents describing process. Please refer to works of Needham

  17. Sue Ieraci says:

    Hi, Joel. It is clearly difficult to double blind a trial of a procedure, but there are well-established shams for acupuncture, for use in single-blinded randomised trials, with blinded data gathering. One such tool is described here: “Validating a new non-penetrating sham acupuncture device: two randomised controlled trials” (BMJ 2002 at http://aim.bmj.com/content/20/4/168.short). It appears that the sensation of a sharp prick, at any location, is part of the placebo effect.

    Here is a multi-site German study, published in JAMA 2005): “Acupuncture for Patients With Migraine
    A Randomized Controlled Trial” (full paper at http://jamanetwork.com/journals/jama/fullarticle/200822?version=meter%20at%20null&module=meter-Links&pgtype=article&contentId=&mediaId=&referrer=&priority=true&action=click&contentCollection=meter-links-click). Both acupuncture and sham arms improved, but 15% those in the no-treatment arm also improved. Of course, this is only one study, but there are many. Unfortunately, not much room to discuss here, but many are discussed in the references.

    It is also worth considering that the huge amoutn of acupuncture research coming out of China almost exclusively shows positive results, as described here:http://s3.amazonaws.com/academia.edu.documents/5430120/vickers_1998_controlled-clinical-trials.pdf?AWSAccessKeyId=AKIAIWOWYYGZ2Y53UL3A&Expires=1486450441&Signature=hqzFXPOKV3aPoZfeAxjseE01dkI%3D&response-content-disposition=inline%3B%20filename%3DDo_Certain_Countries_Produce_Only_Positi.pdf

    While many Aus providers claim they are using “medical acupuncture”, that is not TCM. CHinese acupuncture isn’t used as a way of affecting pain pathways – it is “energy-balancing” medicine, used for everything from turning a breech baby and treating strokes to Cholelithiasis and UTI (source- WHO review).

    I am curious about why clinicians who know very well that acupuncture can’t feasibly change foetal position or treat infections, and yet accept that there may be some undefined impact on pain pathways (yet to be elucidated).

    I accept that most doctors offering acupuncture are genuinely trying to help patients. Why not just offer a relaxing massage, which can also have a strong placebo effect without the risk? Is it acceptable to offer an inactive “therapy” without explaining that the high quality evidence suggests that it acts as a placebo?

  18. Sue Ieraci says:

    Thank you for your comment, Dr Simonov. Sinologist Joseph Needham’s work was, indeed, interesting. His “grand question” was “Why did modern science, the mathematization of hypotheses about Nature, with all its implications for advanced technology, take its meteoric rise only in the West at the time of Galileo [but] had not developed in Chinese civilisation or Indian civilisation?” One major proposal is that Chinese socio-political culture, which was historically strongly Feudal/Totalitarian, “did not make the shift from an experience-based technological invention process to an experiment-based innovation process.” (Lin, 1995). This occurred historically under the dynastic structure, but more recently under Mao. It is argued that the method of experimentation adopted in Europe allowed for faster progress than the personal-experience method used in China, which fails to distinguish association from causation.

    In terms of tools, classical acupuncture employed a range of tools of different shapes for different purposes, which did not look like today’s ultra-fine needles. (ref https://www.chinesemedicineliving.com/acupuncture/anatomy-of-an-acupuncture-needle/)

  19. John Quintner says:

    From my reading on the topic, the most cogent and persuasive article was that published by Colquhoun & Novella (“Acupuncture is theatrical placebo”).

    Here are their important conclusions:

    A small excess of positive results after thousands of trials is most consistent with an inactive intervention. The small excess is predicted by poor study design and publication bias.

    Furthermore, Simmons et al. demonstrated that exploitation of “undisclosed flexibility in data collection and analysis” can produce statistically positive results even from a completely nonexistent effect. They say this is “… not driven by a willingness to deceive but by the self-serving interpretation of ambiguity, which enables us to convince ourselves that whichever decisions produced the most publishable outcome must have also been the most appropriate.”

    With acupuncture, in particular, there is documented profound bias among proponents. Existing studies are also contaminated by variables other than acupuncture, such as the frequent inclusion of “electroacupuncture” which is essentially transdermal electrical nerve stimulation masquerading as acupuncture.

    The best controlled studies show a clear pattern, with acupuncture the outcome does not depend on needle location or even needle insertion. Since these variables are those that define acupuncture, the only sensible conclusion is that acupuncture does not work.

    Everything else is the expected noise of clinical trials, and this noise seems particularly high with acupuncture research. The most parsimonious conclusion is that with acupuncture there is no signal, only noise.

    The interests of medicine would be best-served if we emulated the Chinese Emperor Dao Guang and issued an edict stating that acupuncture and moxibustion should no longer be used in clinical practice.

    No doubt acupuncture will continue to exist on the “High Streets” where they can be tolerated as a voluntary self-imposed tax on the gullible (as long as they do not make unjustified claims).

    NB: there were no conflicts of interest

    Reference: Colquhoun D, Novella SP. Acupuncture is theatrical placebo. Anaesthesia Analgesia 2013; 116(6): 1360-1363.

  20. Joel Hamm says:

    Most acupuncturists are familiar with the contraption designed to be a placebo. Unfortunately it is clearly not. It is a sham device that is far from inert. In fact, it’s sensation can be stronger, given it stimulates the surface of the skin, a highly sensitive tissue. The goal of an acupuncturist is often to quickly insert the needle pas the dermis to avoid discomfort, and attain DE QI afterward. There are also techniques that aim to stimulate the surface of the skin as well.

    Why not get a massage instead? Because people are not the same. As an acupuncturist I often get clients that tried ‘everything’ for their chronic pain. Especially massage because I work at an integrated clinic. More often than not, I am a last resort. Some people I cannot help, but mention of them respond to acupuncture when nothing else could touch their pain.

    Anecdotes are poor evidence, I know, but so is repeatedly pointing to flawed double blind placebo trials.

    Again, this is poor science to continue to adhere to faulty evidence.

  21. Sue Ieraci says:

    Joel – many people resort to “alternative” measures when “all else fails”. Many people have been through the gammut of tests, medications, pain specialists, only to improve with homeopathy. Others get no relief from multiple modalities, then benefit from “chelation therapy” for alleged “heavy metal toxicity”. Others are resistant to everything, but saved by intravenous vitamins, or faith healing.

    Are faith healing, “detoxing” by chelation and homeopathy therefore equivalent to acupuncture?

  22. Sue Ieraci says:

    Thanks to Dr Lim for supplying that extraordinary list from the WHO, which seriously requires an update. Certainly the WHO is not infallible, as evidenced by the need to revise its previously recommended Caesarean surgery rate.

    Are there doctors reading here who provide acupuncture, who seriously think it is plausible that acupuncture could induce labour, resolve foetal malposition or treat leukopenia or stroke?

    In general, the more diverse conditions (of diverse pathophysiology) that a remedy purports to cure, the less likely it is that it cures any (beyond placebo).

  23. Sue Ieraci says:

    Dr van Ballen – you have linked to the abstract of a study for which I cannot access the full paper (it’s likely that other readers are in the same position). Please take us through the methodology of the paper? What is the nature of the pain score they used? Were the differences clinically significant? ANd are you aware of any evidence for acupuncture outside of subjective pain measurement?

  24. Dr Igor Simonov says:

    Sue Leraci it is unbelievable that your argumentation is copy pasted from https://en.wikipedia.org/wiki/Joseph_Needham with quotation of works I believe you didn’t read. Problem is that person who was writing this article committed various mistakes mixing different quotation from wrong authors.
    Wikipedia is not considered a credible or authoritative source https://en.wikipedia.org/wiki/Wikipedia:Academic_use
    I have no question that article produces unbelievable claims and uses deliberate ignorance, when there are artefacts from tombs of 200 BC showing fillliform needles and acupuncture needles having absolutely same form as we use now. I am sorry Sue, I thought it is serious professional talk

  25. Leviathan says:

    Joel Hamm, the defence you use is a common one in the world of alt-med, typical commentary being “this exists outside the Western medical paradigm, and is therefore not subject to the rules of scientific evidence”. This is also known as the fallacy of special pleading.

  26. Joel Hamm says:

    Leviathan – no. You miss my point. My point is to show that focusing on flawed modalities does little to prove the point that acupuncture doesn’t outperform placebo. There is no placebo in said studies. If you cannot see this then you are wearing blinders.

    In addition, Sue, picking and choosing claims that are distasteful as a means of disproving other aspects of the field of acupuncture is a flawed rationale.

  27. Sue Ieraci says:

    Joel – do you agree with the WHO that there is strong evidence for all the conditions in that list? If not, how do you distinguish between them? I’m not being difficult – I genuinely want to know how you could start with an “energy-balancing” modality that is purported to treat all sorts of illnesses to a useful tool for some indications. Surely it is Australian doctors who are “picking and choosing” the indications for acupuncture.

  28. Alan Henness says:

    Dr Selina Lim #11 said:

    “WHO official position…”

    Can you provide a link to the WHO website for that official position?

    Thanks.

  29. Bryan Walpole ( emergency physician) says:

    Well written Sue, maybe you will never silence those critics who fail to read and understand scientific method.
    Acupuncture ( like all else) cannot be proven to do anything.
    As one of your correspondents wrote.. If it works for you, then fine, use and pay, but don’t generalise.
    Medical doctors find its a useful paying sideline methinks. They surely know it is placebo.
    I was around when the AMA supported its inclusion on the MBS, because we had a number of chinese and other members doing it, and there were extensive Mao supported articles about success, most politically tainted.
    It should be removed forthwith following recent trials , methinks

  30. David Colquhoun says:

    It’s well establshed now that if acupuncture has any effects at all, they are too small to be clinically useful.
    If people were still arguing about a drug that had been tested over 3000 times without conclusive results, it would have been ditched years ago,

    The data say that even the placebo effect is roo small to matter. Most of the reason that acupuncture, and other inefective treatments, appear to work is not the placebo effect, but rather a statistical aretefact callled regression to the mean.It’s explained at http://www.dcscience.net/2015/12/11/placebo-effects-are-weak-regression-to-the-mean-is-the-main-reason-ineffective-treatments-appear-to-work/

    The other reason why acupuncture, and other mythical treatments, continue to exist can be attributed to clutching at straws. There are no very effective treatments for chronic pain,and that gives an opportunity for people to jump in with false claims..

  31. George Alcorn says:

    Can someone please point out where the references to level 1 evidence in regard to the clinical and financial benefits of acupuncture, stated by Dr. Ian Relf to exist, actually can be found?

  32. Dieter L. says:

    It’s all very easy .. if medical practitioners would be capable of helping patients effectively, and not just hiding behind their computers trying to find a suitable prescription, than maybe, just maybe, there may be a possibility that patients don’t need to seek help elsewhere.

    Clinical evidence confirms acupuncture works, not like a medical drug by suppressing something, but by supporting a person’s health.

    The best part of course is that we have the choice where we want to go for our Health, therefore anyone who is against Acupuncture obviously doesn’t have go to an acupuncturist.

  33. Dr Bill Meyers ACRRM representative JCCMA Federal President AMAC says:

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5053345/
    “The analyses found acupuncture to be more effective than usual care with respect to reducing pain and improving EQ-5D (EuroQol- 5 dimensional) preference scores in patients with chronic pain of OAK (Osteoarthritis of knee) , musculo-skeletal and headache/migraine origin. The benefits of acupuncture over sham acupuncture are smaller than when compared to usual care.” (Explained by the problems with sham acupuncture controls being an active treatment.) http://www.jsam.jp/onlineJournal/pdf2/67.pdf
    “Furthermore, some of the trials show increased benefits of acupuncture over comparators at 12 [94] and 24 months [95] compared to 3 months. This evidence may be an indication of the long-term clinical benefits of acupuncture and has implications for estimating long-term HRQoL (Health Related Quality of Life) and CE (Cost effectiveness) . Collection of trial data for more than 3 months is therefore warranted together with further work analysing repeated outcome measurements in a NMA (Network Meta-analysis) to evaluate the importance of these effects.”

    Yes, most of the western scientific world and most of the Cochrane collaboration has reached the wrong conclusions about acupuncture, particularly when given in the context of integrated general practice care in Australia.
    In Australia, AMAC (Australian Medical Acupuncture College) fully trained GP’s and specialists make a medical diagnosis about their patient before they consider treatment, whether that includes acupuncture or not. Acupuncture is used as part of patient management, when indicated, and on medical and scientific grounds.

    We need an Australian version of the Baars and Kooreman study: http://bmjopen.bmj.com/content/4/8/e005332
    to determine cost effectiveness in the Australian context, because this is what the Australian Government and the MBS review are interested in -cost effectiveness. Baars and Kooreman findings are often criticised on the basis that some of the GP’s used homeopathy, which has definitely proven to be a placebo treatment (https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cam02_nhmrc_statement_homeopathy.pdf) , and some GP’s used anthroposophic medicine, which has shown to be comparable to conventional high quality GP care (https://www.ncbi.nlm.nih.gov/pubmed/24753995), so the point of difference (pun intended) is that the medical acupuncture cohort actually account for a large proportion of the positive outcome -lower costs, lower mortality.

  34. Sue Ieraci says:

    Bill – it’s easy to allege that others who have analysed the evidence have “reached the wrong conclusion”, but both the scientific plausibility of acupuncture and the actual nature of the evidence disagrees with you. When you back yourself against “most of the western scientific world and most of the Cochrane collaboration”, you really need extraordinary evidence.

    What you have referenced is an article relating to the heterogeneity of methods and data analysis in various trials, using acupuncture for chronic pain as a case example. It confirms that the measured benefits of acupuncture over sham acupuncture are small, and the overall effect sizes are small. The paper seeks to re-analyse this disparate data, with the major limitations that they describe.

    Your further comments about the use of acupuncture by registered medical practitioners begs my original question: “is acupuncture the last bastion of acceptable placebo use in Australian medicine?”

    Let’s see: there are no meridians, it doesn’t matter whether you use needles or toothpicks, or where you position them, or whether you pierce the skin or not, and any measured effect only seems to be for subjective pain. So the answer would have to be ‘yes’.

  35. Dr Bill Meyers ACRRM representative JCCMA Federal President AMAC says:

    Dear Sue,
    most of modern medicine is placebo : Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials BMJ 2015;350:h1225
    http://www.bmj.com/content/350/bmj.h1225
    A Controlled Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
    J. Bruce Moseley, et al N Engl J Med 2002; 347:81-88July 11, 2002DOI: 10.1056/NEJMoa013259

    And, for chronic pain, which is such a huge problem, in Australia, a small benefit above placebo, equates to a large benefit, if enough patients are treated. 8.5 million actually. Ask Chronic Pain Australia members whether they want to pay more for relief of pain.

    As to interpreting complex interventions like medical acupuncture with non inert placebo acupuncture as the comparator – have you seen this paper? :
    An interpretive review of consensus statements on clinical guideline development and their application in the
    field of traditional and complementary medicine
    Hunter et al. BMC Complementary and Alternative Medicine (2017) 17:116
    DOI 10.1186/s12906-017-1613-7

    Also, I note recent research from South Korea and elsewhere that supports the existence of meridians
    Wave-Induced Flow in Meridians Demonstrated Using Photoluminescent Bioceramic Material on Acupuncture Points
    Evid Based Complement Alternat Med. 2013; 2013: 739293.
    Published online 2013 Nov 7. doi: 10.1155/2013/739293

    As to whether needles or toothpicks or where to put them, it depends on whether the patient has hyperalgesia or allodynia. As far as I am aware this neurophysiological phenomenon has not been accounted for in acupuncture trials to date.

    Experimental work in rats confirms the effects of electroacupuncture on hyperalgesia and point specificity
    A parametric study of electroacupuncture on persistent hyperalgesia and Fos protein expression in rats
    Lixing Lao, a, 1, , Rui-Xin Zhanga, 1, Grant Zhanga, Xiaoya Wanga, Brian M. Bermana, Ke Renb

    http://dx.doi.org/10.1016/j.brainres.2004.01.092

    So, the answer is no. There is plenty of placebo about in Western medicine, and less placebo in medical acupuncture, more active treatment, with positive, cost effective outcomes.

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