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Acupuncture practice acts: legalized quackery

As Ben Kavoussi observed recently,

[o]nce considered archaic and obsolete, Oriental Medicine has greatly benefited from the postmodern attitudes towards science and knowledge. This is because postmodernists consider the ‘truth’ as being relative to one’s viewpoint or stance. They do not see science as a superior process of acquiring knowledge, but as a ‘belief system,’ a ‘language game,’ which does not give more access to truth than other conceptual constructs.

This “postmodern fallacy,” he continued,

has allowed the return of mass professional delusions under the label of Chinese, Oriental or Asian Medicine. As an unfortunate byproduct, dangerous and outdated therapies have been legitimized, and quacks and charlatans can overtly defraud those who cannot distinguish scientific medicine from lore and fantasy.

There is probably no better example of this “unfortunate byproduct” than the state acupuncture and oriental medicine practice acts. These laws have indeed legitimized dangerous and outdated therapies, allowing quacks and charlatans to defraud the public.

State practice acts

Via the magic of legislative alchemy, acupuncture, or sometimes, more broadly, Oriental or Traditional Chinese  medicine, is a licensed health care practice in 44 states in the U.S. and the District of Columbia. As with all licensed health care practices, each state defines the acupuncturists’ scope of practice via legislation commonly referred to as a practice act.

Some states, perhaps unwilling to let the genie fully escape the bottle, allow acupuncture only by prescription or under the supervision of a physician. Others, like New Jersey and New York, at least require that an acupuncturist advise patients about the importance of consulting with a licensed physician regarding the patient’s condition. In Louisiana, only physicians can become acupuncturists.

Yet in many states acupuncturists enjoy a broad and unsupervised scope of practice. Here’s a sample of practice acts typical in their definition of acupuncture and oriental medicine.

New Mexico:

‘acupuncture’ means the surgical use of needles inserted into and removed from the body and the use of other devices, modalities and procedures at specific locations on the body for the prevention, cure or correction of any disease, illness, injury, pain or other condition by controlling and regulating the flow and balance of energy and function to restore and maintain health.

‘oriental medicine’ means the distinct system of primary health care that uses all allied techniques of oriental medicine, both traditional and modern, to diagnose, treat and prescribe for the prevention, cure or correction of disease, illness, injury, pain or other physical or mental condition by controlling and regulating the flow and balance of energy, form and function to restore and maintain health.

Florida:

‘Acupuncture’ means a form of primary health care, based on traditional Chinese medical concepts and modern oriental medical techniques, that employs acupuncture diagnosis and treatment, as well as adjunctive therapies and diagnostic techniques, for the promotion, maintenance, and restoration of health and the prevention of disease.

Maryland:

‘Practice acupuncture’ means the use of oriental medical therapies for the purpose of normalizing energetic physiological functions including pain control, and for the promotion, maintenance, and restoration of health.

Colorado:

‘Acupuncture’ means a system of health care based upon traditional oriental medical concepts that employs oriental methods of diagnosis, treatment, and adjunctive therapies for the promotion, maintenance, and restoration of health and the prevention of disease.

Arkansas:

‘Acupuncture’ means the insertion, manipulation, and removal of needles from the body and the use of other modalities and procedures at specific locations on the body for the prevention, cure, or correction of a malady, illness, injury, pain, or other condition or disorder by controlling and regulating the flow and balance of energy and function of the patient to restore and maintain health.

New Hampshire:

‘Oriental medicine means the distinct system of health care that diagnoses and treats illness, injury, pain, or other conditions by controlling and regulating the flow and balance of energy to restore and maintain health.

Nevada:

Nevada is even more expansive in its definition of Oriental medicine, which includes both the practice of acupuncture and herbal medicine. “Oriental medicine” is

that system of the healing art which places the chief emphasis on the flow and balance of energy in the body mechanism as being the most important single factor in maintaining the well-being of the organism in health and disease.

“Acupuncture” is defined as

the insertion of needles into the human body by piercing the skin of the body to control and regulate the flow and balance of energy to cure, relieve, or palliate:

(a) Any ailment or disease of the mind or body; or

(b) Any wound, bodily injury or deformity.

“Herbal medicine” is

Suggesting, recommending, prescribing or directing the use of herbs for the cure, relief or palliation of any ailment or disease of the mind or body, or for the cure or relief of any wound, bodily injury or deformity.

Public health and safety?

A state’s constitutional authority to regulate health care practices is based on the state’s power to protect the public health, welfare and safety. Indeed, some of the practice acts begin with a statement about how the state needs to regulate acupuncture and oriental medicine in the interest of the public’s health and safety. Of course, as Dr. Edzard Ernst pointed out, “the most meticulous regulation of nonsense must still result in nonsense.” With acupuncture and oriental medicine, the nonsense is pernicious.

A cure for disease?

Note how each practice act assumes acupuncturists and oriental medicine practitioners can diagnose and effectively prevent or cure actual disease, among other supposed benefits. One can accept this as true only by believing in the entire traditional oriental medicine myth, aptly defined almost 80 years ago by a Chinese medical school dean as a “weird medley of philosophy, religion, superstition, magic, alchemy, astrology, feng shui, divination, sorcery, demonology and quackery.” I can only assume the good Southern Baptist lawmakers who populate the legislatures here in the deep South, where I live, had no clue about oriental medicine’s true nature when they voted for these practice acts. In fact, I’ll bet the vast majority of state legislators who made acupuncture and oriental medicine a licensed health care practice had no idea that they were legalizing superstition, magic, astrology, sorcery and demonology. They really should pay more attention to what they are voting on.

Legitimizing this “weird medley” has real consequences for the public. Acupuncturists claim they can treat a wide range of diseases and conditions. A small sample includes malaria, anorexia, fever, parasitic diseases, asthma, dementia, depression, epilepsy, paralysis, uterine bleeding, convulsions, heart palpitations, diabetes and jaundice. And it is perfectly legal for them to do so under many of the state practice acts.

Acupuncturists as primary care providers?

In enacting these practice acts, the states give acupuncture and oriental medicine an undeserved imprimatur of legitimacy by making it a form of “health care.” In Florida and New Mexico, it is specifically described as “primary health care.” After declaring oriental medicine is “a system of primary health care,” here’s how New Mexico defines “primary care provider,” and therefore defines an oriental medicine practitioner, in the practice act:

a health care practitioner acting within the scope of the health care practitioner’s license who provides the first level of basic or general health care for a person’s health needs, including diagnostic and treatment services, initiates referrals to other health care practitioners and maintains the continuity of care when appropriate.

Even without such explicit language, by allowing oriental diagnostic methods and treatment “for the promotion, maintenance, and restoration of health and the prevention of disease” the scope of acupuncture practice in some states approaches that of an M.D. or D.O. Compare this to the standard definition of the practice of medicine, this from Florida:

the diagnosis, treatment, operation, or prescription for any human disease, pain, injury, deformity, or other physical or mental condition.

It would appear the only real difference is in the methods of diagnosis and treatment employed. For example, by law an M.D. can treat with surgery and prescription drugs, whereas an acupuncturist cannot. Yet, according to the language of their respective practice acts, both can diagnose and treat any disease.

Adjunctive quackery

As well, these practice acts, and the regulations enacted pursuant to them, give acupuncturists the right to use a smorgasbord of implausible and unproven diagnostic methods and treatments that go far beyond simply using needles to manipulate “qi.”

For example, by incorporating “modern oriental medicine concepts,” the door is left open to add to the existing implausible and unproven “oriental diagnosis and treatment” methods currently being passed off as “ancient.” Simply by labeling a “concept” as “modern,” new “concepts,” no matter how ill conceived, can legitimately fall within the permissible scope of practice.

In addition to “oriental medical diagnosis and treatment,” “adjunctive” or “related” treatments are legally permissible. Because that term is left undefined, again the door is left open to add whatever acupuncturists deem “adjunctive,” whether it be additional forms of quackery or legitimate means that acupuncturists would seem ill-suited to employ. For example, in Florida, the Board of Acupuncture has decided the following are “adjunctive:” reflexology,  laser biostimulation, Kirlian photography, thermograpy, nutritional counseling, lifestyle and stress counseling, and recommendation of homeopathic remedies.

In Arkansas’s practice act, “related techniques” include magnets, cold laser, ion pumping cord, lifestyle counseling, eating guidelines, massage incidental to acupuncture, and exercise techniques. The Arkansas State Board of Acupuncture and Related Techniques has enacted regulations which take the scope of acupuncture practice even further to include ordering radiological, laboratory or other diagnostic tests, Oriental medicine injection therapy, physical medicine modalities and techniques, biofeedback, and prescription or administration of homeopathic medicine, enzymes, and glandulars. The regulations also permit:

The stimulation of points or areas of the body using needles, heat, cold, light, lasers, sound , vibration, magnetism, electricity, bleeding, suction, pressure, Gua Sha, or other devices or means.

That’s right. The barbaric practice of bleeding is legal in Arkansas.

Bleeding is also legal in New Hampshire, thanks to regulations adopted by the New Hampshire Board of Acupuncture Licensing. The Board’s regulations also permit “insertion and retention, for days or weeks, of intradermal needles or press tacks in acupuncture points.” And the Board allows acupuncturists to use (as defined in the regulations):

craniosacral therapy – “a treatment approach using gentle massage pressure to rebalance the craniosacral system”

polarity therapy – “a holistic therapy that combines bodywork, dietary adjustments, and exercises to restore the balance of the body’s vital energy through correction of the electromagnetic field of the body”

reiki – “a Japanese energy therapy that uses energy transmission to balance the biofield that surrounds the human body”

therapeutic touch –“ an energetic therapy . . . that employs a laying-on-of-hands technique based on oriental theories of energy flow”

zero balancing — “a touch technique for aligning the body’s energy and musculoskeletal system”

Which raises a few questions in my mind, if you’ll permit me a bit of digression. If you are sick, how does the New Hampshire acupuncturist know which system is out of whack? Or does being sick automatically mean that all of your systems – craniosacral, electromagnetic, energy flow, biofield and the alignment of your energy and musculoskeletal system – are malfunctioning? If so, it’s going to get awfully expensive to treat your illness. Time consuming too, what with having to spend all that time in treatment. And how does the acupuncturist know when your systems are properly aligned or balanced or flowing or whatever it is they are supposed to be doing?

Conclusion

Just yesterday, Steve Novella observed how the pseudoscience of homeopathy is a fraud being perpetrated on the public and how governments and regulatory agencies which are supposed to protect the public from medical fraud have failed to do so. Here we have yet another example of a pseudoscientific “CAM” practice foisted off on the public as legitimate medicine with the blessing of the government.

Acupuncture and oriental medicine belong in the Middle Ages, not in modern health care. We know acupuncture doesn’t work. And while some of the herbs used in oriental medicine may work, we can’t know that until they go through properly conducted drug trials. Licensing acupuncturists and oriental medicine practitioners and giving them the right to “diagnose,” “prevent” and “cure” disease and to employ other nonsensical “CAM” practices and products is most certainly not in the best interest of the public’s health, safety and welfare. Unfortunately, the problem is only getting worse as acupuncture schools crank out more graduates who then get their state licenses and go into practice.

Posted in: Acupuncture, Legal, Politics and Regulation, Traditional Chinese Medicine

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39 thoughts on “Acupuncture practice acts: legalized quackery

  1. daijiyobu says:

    It seems to me that acupuncture degrees are most often “Masters in Science” and also rather long programs.

    a) that seems absurd when it doesn’t matter where you stick the needles or if you stick the needles;

    b) they often have an herbal component and I’ve actually seen friends with the — in my opinion mysterious in terms of ingredients — bags of twigs that the TCM practitioner gave them to make teas out of.

    And my only question to someone then is

    “are you nuts?”

    -r.c.

  2. NYUDDS says:

    Excuse my repetitive post: It doesn’t matter what we think. It doesn’t matter if it is scientific. It doesn’t matter if it doesn’t work. All that matters is whether the method is licensed in a state, and one at a time, the states fall into line because legislators are scientifically ill-informed and usually driven by votes. Job One is to get re-elected. Kavoussi and Bellamy have written about the ramifications of legal largesse, from Medicare numbers and primary care providers, to insurance access. It will only get worse unless the professional medical community and related fields bring their collective influence to bear on the legislative process. Local and state societies are a good place to start. It will be tough sledding. How many of you saw NY Med last night? My wife informed me that the surgeon, before a long procedure in the OR, usually got acupuncture on his hip first. Millions of people watched! Must be good stuff if NY surgeons use it! Tough sledding, indeed.

  3. tgobbi says:

    Jann quotes Ben Kavoussi: “This is because postmodernists consider the ‘truth’ as being relative to one’s viewpoint or stance. They do not see science as a superior process of acquiring knowledge, but as a ‘belief system,’ a ‘language game,’ which does not give more access to truth than other conceptual constructs.”

    Which might explain a comment a chiropractor made to me a few months ago. He said that his truth isn’t the same as my truth. Perhaps I’m not postmodern enough but I don’t believe that “truth” has a sliding scale. I keep thinking of how, as children, we lie with our fingers crossed behind our backs as if that, somehow, mitigates our fibbing.

  4. Harriet Hall says:

    I just had an article published in Slate about acupuncture in the military.
    http://www.slate.com/articles/health_and_science/medical_examiner/2012/08/quack_medicine_in_the_military_acupuncture_cupping_and_moxibustion_are_endangering_troops_.html

    There are over 1400 comments so far, and they are interesting reading. They illustrate a cross-section of public attitudes about acupuncture, science, and alternative medicine.

  5. After undergrad courses in nutrition and mycology at the post-modern hippy Evergreen State College, I decided to bridge these with my interests in yoga (which had helped me address chronic hip pain) and meditation (which had helped me grow out of religious myopia) by studying herbalism and Chinese medicine. This was around 1994; the public internet was just getting going and cultural relativism was all the rage. Having had issues with completing what I started, I was determined to be a good TCM student and finish the Master’s program no matter what it took. Since SallieMae and State licensing boards gave their blessing of legitimacy to Oriental Medicine’s claims to be a different yet valid medical system, I suspended my suspicions and memorized a huge amount of data and theory. I figured the best way to find out if TCM was true was to learn it as well as possible.
    I’ve tried to talk a couple young people out of going to acupuncture school this past year, as with the advent of the Cochrane reviews and Edzard Ernst’s work, etc., it is pretty clear that most of TCM is, ummm, less effective than proponents often claim (and due to the glut of acupuncturists, most new ones don’t make enough money to pay their bills).
    I’m certainly not “woo-free” as of yet but have moved towards being a vocal critic of illegal, unethical extremes in the Chinese Medicine world, such as this “remedy for venereal disease and ovarian cancers”: http://www.classicalpearls.org/downloads/formulas/OceanPearls.pdf, formulas marketed for people with HIV/AIDS which research has conclusively shown cause harm but no benefit (http://ancientway.com/blog/?p=2309), Astrological Tuning Fork therapy, etc.
    The existing laws are not being enforced. The FDA could and should take action against all three of these examples, but they haven’t and probably won’t. Most of the herb industry, particularly the companies which target acupuncturists, chiropractors, and naturopaths, is clearly breaking the law in how they market supplements. I understand the SBM position of wanting to change the laws to reflect the reality research has revealed about acupuncture and other CAM therapies. It would seemingly be easier to start by enforcing the existing laws. An amendment to the Food Drug and Cosmetics Act to require homeopathics to be proven effective like all other drugs would be a huge and sensible step towards science-based medicine. That would be a lot easier than delicensing existing acupuncturists, naturopaths, and chiropractors!
    Pushing for science-based standards of care in the definition of scope-of-practice for CAM-artists would also be sensible and easier than delicensing, though difficult to pass by the lobbyists. One would hope that educating consumers about basic scientific research principles in medicine would do the trick, but then again some people don’t even brush their teeth…

  6. Quill says:

    This selection of state laws is both enlightening and depressing. I didn’t know that so much circus had been written into such regulations. Bleeding legal in Arkansas and New Hampshire? I wonder if the vampire community knows about this? Perhaps I should check to see if any acupuncture clinics in either state list their hours from sundown to sunrise.

    “Acupuncture and oriental medicine belong in the Middle Ages, not in modern health care. ”

    I think it belongs in a history class, one dedicated to a survey about the way human knowledge has evolved over the last several thousand years. Yet I get the point, that something shown to be based on flawed observations or correlations made long ago should not be taught as a current, effective method on an equal footing with medicine. And it definitely should not be made legal via legislative alchemy.

  7. cervantes says:

    It was more fun when we had pro-quackery interlopers here. The practice of trollery seems to be fading. . .

  8. DevoutCatalyst says:

    @skeptical_acupuncturist

    Do you feel ripped off by your school?

  9. Quill says:

    cervantes lamented: “It was more fun when we had pro-quackery interlopers here. The practice of trollery seems to be fading. . .”

    That is just -your- truth. -You- base -your- fun on objective criteria, such as repeated laughter, while others who embrace the totality of the whole-ality of the multiverses (including the constellation Quackeri Major where Mercury is -never- in retrograde) find humor in non-empirically measured ways, such as diluting molecules out of the known universe and adding sugar to the result. We also like to stick pins in people because the Ancient, Noble, Holistic Art of Voodoo Dolls is, well, just so darn much fun!

    As we ALL know, you science-bounded types consider the “truth” as being unrelated to one’s viewpoint or stance. You see science as a superior process of acquiring knowledge, better than a “belief system,” and certainly not a “language game,” which gives more access to truth than other conceptual constructs and often produces laughter when viewing other stances. Silly you!

    You need help in experiencing non-sciency humor. Therefore it is obvious to anyone with a pulse diagnosis that you need tongue reflexology & laser biostimulation of the interior cheek, a family portrait in Kirlian photography, chiropractic thermograpy of your cranium, zero-balanced nutritional counseling emphasizing vitalized organic trace elements such as Pure Natural Trinity-Site Uranium(c)(r)(tm)(p), lifestyle coaching and therapeutically-touching stress counseling, and professional, state-approved recommendation of homeopathic remedies such as 30X Tittering Album, Cackling Muta, and of course a vial or several of Silver Nitrate, Arsenic Trioxide, and a range of attractively packaged tinctures of Mercury.

  10. qetzal says:

    @NYUDDS, re: NY Med

    I saw that series listed in my online TV guide the other day. When I hit the info button and saw who’s in it, I almost puked. Dr. Oz has a prime-time medical series?!!

    We’re doomed!

  11. nwtk2007 says:

    Not so cervantes.

    Its amazing how something like acupuncture has lasted for millennia with so many convinced that it worked. But then again, there are probably a few science based folks on this site who actually believe the lies Romney spues forth.

  12. Scott says:

    The idea that “acupuncture has lasted for millennia” is a lie. Acupuncture was invented by Mao. The supposed ancient acupuncture was in fact bloodletting no different than was used in Europe.

  13. nwtk2007 says:

    Oh no, no Mr Scott, it has a great history as this incredible website would attest to. It is obviously one of the more scientific websites you could run across.

    http://www.drmanik.com/chap1.htm

  14. @ Devout Catalyst
    I don’t feel ripped off by my school because in the 1990s it seemed like acupuncture and TCM was beginning to be confirmed by research. The attitude was “it’s no longer a question of IF acupuncture works but HOW it works.” Today, anyone familiar with the best research is back to the question of IF it works better than placebo for a limited number of conditions.
    Today acupuncture schools are ripping off students as it’s now clear most graduating acupuncturists can’t make a living, and research has disproven many claims which the schools still make.
    That being said, there were certain things I was taught which were known to be hokum at the time (like External Qi Healing). But I “hired” my school to help me get my license, and they accomplished that goal.
    More importantly is the issue of whether (I feel like) I’m ripping off patients. After absorbing the skeptical literature, I’ve moved towards only treating the things which acupuncture has shown some hope of treating better than placebo (tension headaches, neck pain, tennis elbow, knee pain, low back pain, etc.) and use my crazily huge scope of practice (Oregon) to use massage, exercise therapy, dietary advice, TENS/PENS, and basic lifestyle counseling (including lots of attentive listening) to maximize the plausible value I give to my patients. I also have diversified my income so I’m not totally dependent on TCM, and am accelerating those efforts.

  15. michaelSkiCoach says:

    I’m sorry to say that Canadian governments are no better. Alberta just announced the regulation of Naturopathic doctors.

    Partial quote from the Globe and Mail is below :
    —————
    “This is an amazing day for naturopathic doctors,” said Kim Lena, a naturopath who hosted Mr. Horne’s announcement.

    They’ll be allowed to perform injections; minor surgeries, such as wart removal; ear exams; and, with additional training, other procedures such as the use of some intravenous treatments.

    They can’t prescribe drugs or order x-rays.

    The Alberta College of Physicians and Surgeons was among other professional groups consulted about the change, and supports it. “Regulating naturopathy will help protect the public and ensure consistent standards and quality – and that’s positive for the profession and for patients,” spokesperson Kelly Eby said in an e-mail.

    At minimum, naturopaths take three years of “pre-medical education” before a four year accredited professional program.

    “We offer Albertans a distinct system of primary care that is an art, a science, a philosophy and a practice of diagnosis and assessment, treatment and intervention of illness,” said Allissa Gaul, an Alberta naturopath who averages 600 new patients a year and will serve as the college’s first president. Naturopaths typically focus on wellness, dietary concerns and herbal or homeopathic treatments, she said.

    source: http://www.theglobeandmail.com/news/national/alberta-gives-naturopaths-full-status-as-medical-professionals/article4441076/

    ——————–
    The scariest part is that the The Alberta College of Physicians and Surgeons endorsed it!

    Well I guess there will be no more patronizing jokes about my American friends …

  16. pmoran says:

    More importantly is the issue of whether (I feel like) I’m ripping off patients. After absorbing the skeptical literature, I’ve moved towards only treating the things which acupuncture has shown some hope of treating better than placebo (tension headaches, neck pain, tennis elbow, knee pain, low back pain, etc.) and use my crazily huge scope of practice (Oregon) to use massage, exercise therapy, dietary advice, TENS/PENS, and basic lifestyle counseling (including lots of attentive listening) to maximize the plausible value I give to my patients.

    Also, what are your patient’s expectations of you as an OM practitioner? Specifically, what percentage of your clients have ones which could put their life or limb at risk? That basically devolves mainly into whether they are eschewing conventional medical care for serious conditions.

    To what extent would your training have had you advising people to stop using conventional doctors?

    Finally, don’t be shy — do your results from acupuncture encourage you to believe you are helping people with those conditions in some “real” way?

  17. @skeptical_acupuncturist,

    I appreciate the tone you write in, but you just admitted to bleeding your customers dry using any means necessary. Jeezus. YOU SHOULDN’T BE TREATING NECK, KNEE, OR BACK PAIN. YOU ARE NOT IN ANY WAY A HEALTH CARE PROVIDER. I don’t care what some slick willy got slipped by your state’s “licensure” department. You are not a health care provider. They are not your patients, and you do not treat them. From your own admission, you are simply doing a bunch of voodoo on them hoping it may help. IF YOU WANT TO HELP PEOPLE, SEND THEM TO A LEGITIMATE MEDICAL PROFESSIONAL.

  18. @ Pmoran–Most of my current patients have already been to conventional care. Many of them are referred from their MD, PA, or PT for my services. I often recommend that patients go to an MD for diagnosis or tests if it is unclear where their pain or other symptoms are coming from.
    Some of my training emphasized making appropriate referrals. Other courses were more critical of mainstream medicine. Certainly the basic premise of TCM is that it can diagnose and treat almost any condition (i.e. group of symptoms differentiated into TCM pattern). I think most educated consumers are somewhat aware of the limitations of an acupuncturist, though certainly there are those who feel we have great mystical insights superior to MDs. I try to correct those misunderstandings both in my clinic and blog.
    As far as results, I have many patients who are adamant that my acupuncture has helped them significantly in cases of headaches, back pain, knee pain, elbow pain, shoulder pain, and shingles pain. Often the results appeared immediately after a treatment and last indefinitely, even after pain which has been stable for years. I also have had many patients who tried a couple treatments, saw no benefit, and stopped coming. I just got out of a treatment room with an older lady who was recommended rotator cuff surgery 3 months ago but couldn’t bear the thought of not using that arm for 6 months, so chose to come for acupuncture instead. She is doing fine and is thrilled with the results–in her mind the value she has received from acupuncture is very high (even if just placebo while her shoulder healed on its own), only outdone by her suspicion of the surgeon. I did just recommend she get cataract surgery by telling her that it was safe, effective, and there are no herbs, etc., which have been shown to reverse cataracts.
    @ SkepticalHealth–wow, you win the award for fallacious overgeneralizations today! And you’re wrong. I certainly didn’t admit to “bleeding your customers dry using any means necessary.” I am well aware of the marketing tactics and ‘customer retention techniques’ taught in Chiropractic seminars, etc. I do not use any such methods, and am much more likely to say “I think you’ll be just fine, and I’m not going to pressure you to reschedule, you can let me know if you want to come in again.” More importantly, I am definitely a health care provider, as much as it burns you. You may say “I don’t consider you to be a legitimate medical provider” but when you make it a more general statement you are in error. By polarizing so adamantly, you do more than anyone to make me defend acupuncturists, and you make skeptics look like jerks. I have a medical license. I am a health care provider. I have patients. I do treatments. I make prescriptions. More than most acupuncturists, I try to be rational and use scientifically plausible treatments in my medical clinic. I definitely didn’t admit to “simply doing a bunch of voodoo” on my patients. You are the one doing voodoo on the straw man you’ve made of me. Have at it, I don’t believe it will work.
    My next patient is almost here. Her daughter died from prescription drug complications. She (her mother, my patient) has fibromyalgia. Her therapist recommended she try my services. She found they work well for her, but has talked me into doing 15 minutes of massage before I do acupuncture. She insists on paying me more to do it that way. She’s not at all interested in taking prescription drugs for her pain, and chooses to come in every 2 weeks to maintain her relief.
    Part of your fallacy, SkepticalHealth, is to pretend that the mainstream medical world is science-based and has the corner on the “safe and effective” market (and the corner on being called “health care”). Most consumers of alternative medicine don’t fall for that argument.

  19. History

    Acupuncture is an alternative medicine that claims to treat patients by inserting needles into the body along mystical lines called meridians which supposedly results in an alteration of a life force known as qi.

    The history of this practice is relatively well known. Many proponents claim that acupuncture is many thousands of years old, and this view is held very strongly by practitioners who believe the practice has evolved over thousands of years of trial and error resulting in a well refined system. To believers, this supposed tradition outweighs modern scientific evidence refuting the effectiveness of the practice. Unfortunately, these claims are not supported with historical evidence. It is likely that modern acupuncture may never have existed in ancient China in the same form that is practiced today.

    Several ancient Chinese medical texts have been discovered that shed light on the practices of the time. Shiji (English: Records of the Grand Historian, written circa 90 BCE), for example, mentions the therapeutic use of needles, but only for the purpose of lancing abscesses or draining infected joints rather than for acupuncture.

    The Huang Di Neijing (English: Yellow Emperor’s Inner Canon), is an ancient Chinese text which is the source for Traditional Chinese Medicine. The Huang Di Neijing was written in multiple sections over a span of many hundreds of years. The earliest mention of this book was in a chapter of Hanshu (English: Book of Han) written in 111 CE, however the primary content of Huang Di Neijing was written between 500 and 800 CE, with final revisions being completed in the 11th century CE.

    This text described qi, the supposed life force, which travels along mai, which are imaginary channels running through the body that were associated with diagnosis and treatment. Mai may have inspired the idea of meridians as utilized by modern acupuncturists, but the term meridian was not invented until 1939.

    The Huang Di Neijing mentioned needles, but not for the use of acupuncture, and does not mention using needles along mai for any therapeutic purposes. Instead, the text references needles being used for lancing abscesses and draining infected joints.

    The text also describes needles being used for bloodletting, which is an ineffective practice that drains blood from the body, supposedly to rid it of bad “humors.” Bloodletting is accomplished by puncturing the skin with an object or by placing leeches on the skin. Some scholars believe that acupuncture evolved from bloodletting. Because bloodletting is ineffective and dangerous, simply placing needles in the surface of the skin, without drawing blood, would give the same placebo benefit without the risk of exsanguination.

    During the Song Dynasty (960 – 1279 CE) there was an early version of acupuncture being developed. In 1023, the Emperor Renzong of Song ordered the production of a bronze statue demonstrating the acupuncture points used at the time. Over the next few hundred years acupuncture fell out of favor to more effective professions and became a minor tradition in lower-class populations that did not have access to health care.18

    People began to doubt the effectiveness of acupuncture early on. Early writings noted that if one does not believe in “needling”, one should not use it. It’s rather telling that acupuncture’s effectiveness was doubted even in pre-scientific times. In 1822, in an attempt to modernize medicine, the Chinese government banned the teaching of acupuncture at the Imperial Academy of Medicine. Japan followed suite in 1876.

    This banning did not last. Early Chinese Communist Party leaders scorned acupuncture along with other traditional Chinese practices and identified them as “superstitions, irrational, and backwards.” In the 1950s and 1960s, Communist Party Chairman Mao Zedong flipped positions and began advocating the use of acupuncture and other traditional Chinese medicines as a way to provide health care to his very large population without spending a large amount of money. Acupuncture was cheap and practitioners did not require much, if any, training. It was during this resurgence that much of the theory and practice of acupuncture was written and established.

    Part of Mao’s strategy to promote acupuncture and other traditional Chinese practices was to be “at odds” against Western practices. However, evidence finds that Mao used Western medicine and shirked Chinese medicine. This isn’t a surprising finding, because Mao’s veiled attempts to provide health care for his population were decisively self-serving.19

    Acupuncture’s popularity has waxed and waned several times in the West. Europe and the USA saw a increased use of acupuncture in the early 1800s, during the same time China was working to ban the practice. Believers used acupuncture for every condition imaginable, from cholera to drowning victims. After consistently experiencing failures with acupuncture, the practice was ultimately rejected and abandoned.20

    In 1821, the editor of the journal Medico-Surgical Review described the rapid decrease in use of acupuncture:

    A little while ago the town rang with “acupuncture”, everybody talked of it, everyone was curing incurable diseases with it; but now not a syllable is said upon the subject.21

    Acupuncture was largely forgot about in the West until 1972, when US President Richard Nixon visited China. At the time, China had just reinstated the use of acupuncture and was anxious to prove to the West their superiority. During this visit, the delegation was shown a patient undergoing surgery using acupuncture instead of modern anesthesia. Upon returning to the United States, members told the story of this amazing practice the Chinese had developed.

    This supposed acupuncture anesthesia turned out to be a farce. It was discovered that the patients undergoing surgery received morphine through an intravenous drip which was claimed to only contain “fluids and nutrients.” The patients were also carefully selected, requiring someone who had a high pain tolerance and who was susceptible to heavy indoctrination (“Do this for your country!”)

    Despite these revelations of Chinese fraud, acupuncture experienced another resurgence of popularity in the West.

    Philosophy

    Modern acupuncture is based around the belief of a vitalistic life energy which flows through the body called qi. Any disturbance of qi is believed to be responsible for disease, and disturbances of qi are thought to be rectified by inserting thin metal needles into certain areas of the body termed acupuncture points.

    Properly functioning qi is said to flow from inside the body to outside the body along presumed “channels” referred to as meridians. Acupuncturists name 12 meridians, a number that was picked due to the great rivers of China. Along these meridians and outside of them are thought to be 365 acupuncture points, a number that was picked because of the number of days in a year. This number is much greater now due to the expanded practice of acupuncture.

    Practice

    An encounter with an acupuncturist typically starts off with a lengthy and comprehensive consultation. Indeed, studies have found this is likely the most important part of the encounter and is responsible for any perceived benefit from acupuncture (see “Investigations” in this chapter.)

    Because acupuncturists believe disturbances in qi are the cause of disease, they eschew proven causes of disease such as bacteria, autoimmune conditions, and inheritable disorders. They also do not utilize modern diagnostic tests and techniques because they do not investigate the body in the framework of qi.

    Therefore, instead of diagnosing an infection by taking a patient’s temperature and culturing bacteria in a medium, or diagnosing diabetes by checking a blood sugar level, the acupuncturist will focus on other parts of the body. Acupuncturists believe that the pulses in the wrist correspond to the different internal organs, which supposedly allows them to diagnose conditions by merely palpating arteries. They also believe the tongue contains a map of the entire body. For example, if they notice teeth marks on one part of the tongue then they conclude the patient has a heart condition, while other marks may supposedly indicate a problem with the pancreas or other organs.

    Based on information presumably obtained by the lengthy consultation, palpation of the wrist pulses, and examination of the tongue, the practitioner will then place very thin stainless steel needles into the skin at different acupuncture points in order to help balance qi in the patient. The needles may be left in the skin for any period of time, ranging from a few minutes to a few days.

    Not all patients report pain, but the insertion of the acupuncture needle is painful and has been described as “unpleasant.” Multiple studies have had patients drop out because the needle insertion was too painful to bare. Japanese acupuncture uses a smaller needle than Chinese acupuncture which apparently helps decrease pain.

    Investigations

    Acupuncture lacks any plausible mechanism of action. There is no scientific basis for qi, meridians, or acupuncture points and they have never been detected, observed, or otherwise proven to exist. It has never been established that acupuncture works for any specific medical condition. Because it was possible that acupuncture works in some undiscovered way, research was warranted and a plethora of investigations have been performed which overwhelmingly find that acupuncture is nothing more than an elaborate placebo.

    The gold standard in research is the double-blinded, randomized controlled trial. Briefly, controlled refers to a study having at least two groups of patients: a treatment group that receives the drug or treatment being tested, and a control group that receives a placebo which has no treatment effect. Randomization assigns, without bias, patients to either the treatment or control group, to ensure the greatest likelihood that any difference in the makeup between the groups is a result of chance. Double-blinded refers to both the researchers and patients not knowing if they are part of the treatment or control group; a third-party keeps track of who is receiving which treatment.

    A double-blinded, randomized controlled trial is easy to perform when testing medication because a placebo sugar pill can appear identical to the drug being tested. This makes it easy to blind both the researcher and the patient. However, when the intervention being tested is invasive in nature, such as acupuncture, it becomes very difficult to blind both parties.

    Early research in acupuncture was plagued with multiple problems resulting in a large number of poor quality studies. One major problem was inadequate control groups. For example, some studies had no control groups, which made it impossible to determine if acupuncture had any effect. Other studies had control groups in which the treatment group would receive acupuncture, and the control group would receive an electrical shock on the wrist, which clearly was inadequate.

    These poor control groups led to the next major problem with early studies, which was a complete lack of blinding. The researcher was well aware whether they were administering acupuncture or a wrist shock; likewise, the patients were equally well aware if they were being provided treatment or placebo. Patient’s don’t typically experience a significant benefit from placebo if they are aware they’re receiving it. This makes a poor quality study, the findings of which aren’t useful. These problems weren’t necessarily the fault of lazy researchers, instead the problem was a lack of imagination in finding a way to trick the control group into believing they were receiving acupuncture while actually providing sham, or placebo, acupuncture.

    Recent research has solved these problems. To create adequate control groups, researchers have employed the use of needles with tips that retract into the shaft. These telescoping needles provided the impression of acupuncture without penetrating the skin. Because the researcher knows whether the needles are true or sham, but the patient doesn’t, these studies are considered single-blinded. Double-blinded would be ideal, but single-blinded is much better than no blinding.

    Another issue that made studying acupuncture difficult is separating the effectiveness of the treatment from the effectiveness of the clinical encounter based around the treatment.

    Research from homeopathy, which is a placebo-based therapy in which pure water is given to patients with the promise that it contains an infinitely diluted “active” ingredient, has shown that the presumed benefit from the treatment is gained from the lengthy clinical consultation, and not from the actual placebo remedies prescribed by practitioners. (See chapter “Homeopathy”)

    Acupuncture has an effect in a similar way, but what separates it from homeopathy is the the fact that acupuncture treatment is unpleasant and sometimes very painful. Combining a physically demanding treatment with a lengthy consultation and a ritualistic physical exam complicates the encounter and provides many sources for perceived benefit that need to be teased out when determining the efficacy of the treatment itself. It is understandable that a patient, being coached and motivated by their acupuncturist as they endure an unpleasant procedure, would expect to have a significant reduction in their pain. After all, why would they go through all of the trouble if they weren’t expecting results.

    Because the vast majority of acupuncture studies find the treatment is no better than placebo for any condition, investigators have became more interested in understanding exactly how the clinical encounter affects the perceived benefit of the treatment.

    In 2011, a study compared the effects of traditional Chinese acupuncture to sham acupuncture for patients with arthritis of the knee while controlling for the effect of the acupuncturists’ communication style. Subjects were first broken into two groups. In one group the acupuncturists conveyed positive expectations with phrases such as “I think this will work for you” while the second group received neutral expectations such as “It may or may not work for you.” Within each of these groups, patients were administered either real acupuncture or sham acupuncture. The authors found that there was no difference in the effectiveness between acupuncture and sham acupuncture in each of the groups, showing that the treatment itself is equal to placebo. However, the authors did find that patients receiving positive expectation phrases had a small, but significant, improvement compared to the patients receiving neutral expectations. This was a rather outstanding finding: by championing the treatment, the practitioner could elicit a greater response in their patients. The authors concluded that for knee arthritis, acupuncture is no better than placebo, and perceived benefit is gained from a high expectation communication style.22

    The story doesn’t end here, however.

    In 2011, an interesting study evaluated the effectiveness of acupuncture for osteoarthritis. Patients with significant joint pain were randomized into three different groups: the first group received real acupuncture, the second received sham acupuncture with non-penetrating needles, and the third group received mock electrical stimulation. The groups were further divided into empathetic or non-empathetic consultations. Patients receiving empathic consultations were greeted in a warm and friendly manner and were free to enter into conversation with their practitioner, and the practitioners did everything possible to ensure the patients’ comfort and well-being. Patients receiving non-empathic encounters were greeted in an efficient manner and quietly shown to the treatment area. Practitioners only discussed matters directly related to treatment, and explanations were kept as short as possible, and they refused any attempt at non-treatment related conversation. This group structure was performed by three different practitioners.

     Three practitioners each provided both empathic and non-empathic treatments of real acupuncture, sham acupuncture, and mock electrical stimulation.

    The study found that within the empathic and non-empathic groups, there was no difference between real acupuncture, sham acupuncture, or mock electrical stimulation in any measured outcome including reduction of pain. This tells us that if the clinical encounter is adequately controlled for, we find that real acupuncture is no better than placebo. We can then infer that any perceived benefit from acupuncture comes from the clinical encounter, and not the treatment, because as we have just seen, the treatment itself is irrelevant. Fake acupuncture and simply shocking the patient performed just as well as sticking needles in them.

    This study had several other interesting findings. One would expect that people receiving the empathic consultations would have experienced a greater improvement in symptoms than those receiving non-empathetic consultations. This was not the case. All patients reported improvement, regardless of whether they were in the empathic or non-empathic groups, and regardless of which intervention they received. The authors speculated that this may have been because the patients were able to tell that the practitioner was being purposefully cold to them.

    Another interesting finding was that the third practitioner had greater pain relief in both his empathetic and non-empathic groups, in all three treatment modalities, than the other two practitioners. The authors believed that practitioner 3, being an older male (in contrast to practitioner 1, who was a younger female) was seen as more of an expert and possibly established a higher expectation of success which influenced outcomes.

    The authors concluded that acupuncture has no specific efficacy over either placebo tested (sham acupuncture or mock electrical stimulation.) They also noted that the individual practitioner and the patient’s belief had a significant effect on outcome.23

    Unsurprisingly, as the methodological quality of research has improved, and researchers are able to adequately control for so many different variables, it’s been found that acupuncture is nothing more than a very elaborate placebo. Any perceived benefit is seemingly due to the consultation process preceding treatment. The treatment received is irrelevant.

    In 2009, a systematic review examined whether there is any difference in efficacy between traditional acupuncture and sham acupuncture. The review found that the overwhelming majority of studies find that acupuncture is no more effective than placebo acupuncture, which the authors stated casts doubt on the validity of traditional acupuncture theories and acupuncture points.24

    The fact that there is no scientific validity to the proposed mechanism of acupuncture along with the fact that the vast majority of high quality evidence finds that acupuncture has no treatment effectiveness beyond placebo has backed practitioners into a corner. They had to choose one of two options: admit that their practice is essentially ineffective, or find some way to spin the data.

    Unsurprisingly, acupuncturists chose to spin the data. In the journal Acupuncture in Medicine, several acupuncturists published an opinion piece making the absurd claim that all research which shows acupuncture is no more than placebo is wrong because:

    Sham acupuncture evidently is merely another form of acupuncture from the physiological perspective, the assumption that sham is sham is incorrect and conclusions based on this assumption are therefore invalid.25

    It is important to point out what sorts of interventions have constituted sham acupuncture. Non-penetrating needles have been used, as have toothpicks, electrical wrist shocks, and other such devices. Further, when sham acupuncture is administered, practitioners are careful to not use “known” acupuncture points. The author’s contention that sham acupuncture is just another form of acupuncture is dishonest, despicable, and they clearly were grasping at straws (or needles.)

    The National Council Against Health Fraud stated:

    Acupuncture’s theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge.26

    Below are a handful of systematic reviews evaluating the effectiveness of acupuncture for different medical conditions. By no means is this list comprehensive or all-inclusive.

    Pain Disorders

    In 2002, a systematic review evaluated the effectiveness of acupuncture for the treatment of lateral elbow pain, also known as tennis elbow, with respect to a reduction in pain, improvement in function, and grip strength. There were no significant reductions in pain in either short term (24 hours) or long term (3 or 12 months.) The authors concluded there was no evidence to support the use of acupuncture (by either needle or laser) for the treatment of lateral elbow pain.27

    In 2005, a systematic review investigated the effectiveness of acupuncture for the treatment of shoulder pain. Nine trials were evaluated, but obtaining data was difficult because most had very poor methodological quality. The review found no evidence that acupuncture is an effective treatment for shoulder pain.28

    In 2008, a systematic review evaluated the effectiveness of acupuncture as a treatment for rheumatoid arthritis. Eight studies were evaluated. The review found that acupuncture had no specific effects such as reduction of pain or joint swelling in patients with rheumatoid arthritis.29

    In 2008, a systematic review investigated the effectiveness of different alternative therapies, including acupuncture, for the treatment of neuropathic pain (such as diabetic neuropathy.) Acupuncture, along with many other alternative therapies, was found to be ineffective for the treatment of neuropathic pain. The review did find that topical capsaicin cream was effective beyond placebo.30

    In 2009, a study investigated the use of acupuncture for back pain. In this study’s control group, the researchers used toothpicks to poke the patients at non-acupuncture point sites and found that this sham treatment was equally effective (or ineffective) as traditional acupuncture. The authors found that there was no difference between traditional acupuncture and sham acupuncture for back pain.31

    In 2011, a massive systematic review of systematic reviews evaluated the evidence supporting the use of acupuncture for pain relief. Fifty-seven systematic reviews were considered. The review cast serious doubt on whether acupuncture is effective for any medical condition, with the possible exception of neck pain. However, the review discussed how biases, conflicting conclusions, and recent high quality studies cast doubt on even that indication. The authors concluded that there is truly little evidence that acupuncture is effective in reducing pain.32

    Neurological Disorders

    In 2007, a systematic review evaluated the effectiveness of acupuncture or several of its variants for people with insomnia. Seven trials were evaluated totaling 590 participants. The authors found no evidence to support the use of any form of acupuncture for the treatment of insomnia.33

    In 2008, a systematic review evaluated the effectiveness of acupuncture for people with epilepsy. Eleven trials with 914 total participants were evaluated. Acupuncture had no effect on all variables examined, including frequency of seizures, the number of seizure-free weeks, or quality of life. The authors concluded that there was no evidence that acupuncture is effective for the treatment of epilepsy.34

    In 2008, a systematic review examined the effectiveness of acupuncture for the treatment of restless leg syndrome. 14 studies were identified but many of them were not evaluated due to poor methodological quality. Of the studies evaluated, the authors found no evidence that acupuncture is effective for the treatment of restless leg syndrome.35

    In 2008, a systematic review evaluated the usefulness of acupuncture as a treatment for Parkinson’s disease. Eleven trials were found and analyzed. The review found no convincing evidence that acupuncture is a useful treatment for Parkinson’s disease.36

    In 2009, a systematic review evaluated the effectiveness of acupuncture for the treatment for Alzheimer’s disease. Three studies were identified and evaluated. Two of the studies compared drug therapy to acupuncture and found that drug therapy was significantly better than acupuncture. The review found no evidence that acupuncture is effective for Alzheimer’s disease.37

    In 2009, a systematic review evaluated the effectiveness for acupuncture in treating alcohol dependence and its symptoms. The review found no evidence that acupuncture is an effective treatment for alcohol dependence.38

    In 2009, a systematic review evaluated the effectiveness of acupuncture for the treatment of schizophrenia. Thirteen trials were found, all originating from China. The reviewers found the trials were all of poor methodological quality and no high quality evidence was found to support the use of acupuncture for schizophrenia.39

    In 2010, a systematic review evaluated the effectiveness of acupuncture in hastening recover and reducing long-term morbidity from Bell’s palsy (a problem with the facial nerve, which controls muscles of facial expression.) Six trials involving 537 subjects were reviewed. No evidence was found that acupuncture is of any use for patients with Bell’s palsy.40
    {}
    In 2011, a systematic review investigated the effectiveness of acupuncture for people with autism in improving autistic features as well as communication, cognition, overall functioning and quality of life. Ten trials involving 390 children were evaluated. No evidence was found that acupuncture is helpful for autism or any of its related symptoms. Several adverse effects were noted, including bleeding, crying due to fear or pain, irritability, sleep disturbances and increased hyperactivity.41

    Hormonal Disorders

    In 2009, a systematic review evaluated the evidence for the use of acupuncture to treat erectile dysfunction. Very little high quality data was found. The review concluded that there was insufficient evidence to suggest that acupuncture is effective for treating erectile dysfunction.42

    In 2009, a systematic review assessed the effectiveness of acupuncture as a treatment for menopausal hot flashes. Multiple randomized controlled trials were evaluated. The review found there was no evidence supporting the use of acupuncture for the control of menopausal hot flashes.43

    In 2009, a systematic review evaluated the effectiveness of acupuncture for treating hot flashes in patients with breast cancer. Several studies were found and evaluated. The authors found no evidence that acupuncture is effective for the treatment of hot flashes in breast cancer patients. In studies that compared hormonal therapy to acupuncture, hormonal therapy was significantly better than acupuncture.44

    In 2009, a systematic review evaluated the effectiveness of acupuncture for the treatment of hot flushes in men with prostate cancer. Six studies were identified, but only one was a randomized control study. The review found no evidence that acupuncture has any effect for the treatment of hot flushes in men with prostate cancer.45

    In 2009, a systematic review assessed the effectiveness of acupuncture to reduce menopausal symptoms. 11 studies, which included 764 individual cases, were evaluated. The review concluded that there is no evidence that acupuncture is an effective treatment compared to sham acupuncture for reducing menopausal symptoms.46

    In 2010, a systematic review evaluated the effectiveness of acupuncture for the symptomatic treatment of primary dysmenorrhea (pain during menstruation.) Twenty-seven reviews were analyzed. The authors found no evidence that acupuncture had any greater effect than sham acupuncture.47

    In 2010, a systematic review evaluated the effectiveness for acupuncture in the treatment of premenstrual syndrome. Nine studies were found an evaluated. The review found no evidence that acupuncture is beneficial to patients with premenstrual syndrome.48

    Safety

    Acupuncture is not without risk. The estimated rate of adverse effects range from 1 in 20 to 1 in 10 treatments. While the majority of adverse effects are relatively minor, such as bleeding, bruising, and dizziness, very serious effects and death have been reported. Many patients have contracted bacterial and viral infections from unclean needles. Patients have had numerous injuries due to the needles being pushed too far into the skin, including nerve and organ damage, and brain damage and stroke due to needling at the base of the skull. One of the most common causes of death from acupuncture is puncturing the lining of the lungs, causing pneumothorax.

    As with other alternative treatments, even one death is too many for a practice that is not effective for any medical condition. Patients who pursue acupuncture as their only means of medical care are at risk due to delaying onset of conventional medical care.

    In 2001, a study ascertained the incidence of adverse events related to acupuncture treatment. The study noted serious adverse events including lost or forgotten needles in the patient, skin infection, long-lasting pain at the site of needle entry (greater than two weeks), fainting, nausea and vomiting, lethargy, long lasting disorientation (greater than one day), anxiety, headache, numbness in the skin, slurred speech, and worsening of symptoms including back pain, fibromyalgia, shoulder pain, vomiting, and migraine.49

    In 2011, a systematic review of systematic reviews examined reported incidents of serious adverse effects occurring after acupuncture treatment. Most patients had been to an acupuncturist for relatively minor problems. Thirty-eight cases of infection were reported, resulting in abscesses in the skin and spine, infected joints, necrotizing fasciitis, syphilis, and HIV. Forty-two cases of organ trauma were reported, including pneumothorax (from which multiple patients died), spinal cord injuries resulting in permanent neurological deficits, nerve injuries, bleeding into the carpal tunnel, broken needles in the neck, aneurysms in arteries, cardiac tamponade, and sadly the traumatic creation of a pathway (fistula) between the aorta and the intestine (resulting in death). Other adverse effects included seizures, different nerve injuries, and even skin cancer due to chronic irritation from repetitive needle insertion. All of these conditions which didn’t kill the patient ultimately required conventional medical treatment for management.50

  20. ^ An article I wrote about that horrific field of quackery known as accupuncture.

  21. And congratulations on using massage therapy. It’s the one “treatment” skill that everybody past the age of 7 has mastered. There are no entry requirements (not even a high school diploma) for massage therapy school, the tests are open book, and you get a packet of questions that appear on the “board exams” to memorize for the “boards.” Massage may feel great, but to write about utilizing it as if you convey anything positive to a patient is laughable. I massage my wife’s feet (don’t be jealous Harriet), does that make her my patient? Quack.

  22. pmoran says:

    If you examine skeptical_acupuncturist’s specific claims, SH, you will note that they are not precisely contradicted by your studies.

    Patients do claim to be helped by the methods he used.

    He is not claiming to be applying mystical Eastern philosophy.

    In many of the studies you quote sham acupuncture consistently appeared to induce benefits of moderate effect size. That has relevance in forbidding some possible mechanisms of action but it says nothing in and of itself as to whether patients have been helped (or not) in other ways, such as via the power of suggestion, or other non-specific influences such as relaxation, reassurance, or counterirritation. There is substantial scientific evidence for these possibilities.

    So try again, explaining why SA, a person who is obviously quite amenable to reasonable scientific argument, merits your abuse. Passion is fine. Being right in most things is fine. But they should not to be allowed to result in people being treated unfarily, or little misrepresentations of what the science actually permits us to say. Medicine is a very complicated human activity.

  23. If we all debated CAM-quacks in the way that pmoran wants us to, we’d drive to each of their houses, felate them, and then get on all fours and beg them to reconsider.

  24. Well, if ALL CAPS doesn’t work, try pasting in several pages of text. You lost points for abusing an apostrophe. Also, your specialty of overgeneralizing continues to lose me. I believe in germ theory and don’t believe an imbalance of “qi” causes disease. As some other relatively skeptical acupuncturists believe, I think “qi” is best understood as oxygen.
    I don’t disagree with most of your paper. Note that most of the studies are from after 2000, and the best ones are from the last couple years. This is why I say that my acupuncture school didn’t rip me off in the mid 1990s, but today they know better and are deceiving their students.
    Percutaneous Electrical Nerve Stimulation, often called electroacupuncture, seems to have stronger pain-relieving abilities than standard acupuncture (though not all research agrees). This is in my scope of practice and I use it regularly. It’s not uncommon for critics to say “yes, but that’s not acupuncture.” It’s certainly not traditional acupuncture, but it is within my scope of practice. As are exercise therapy, dietary/nutritional therapy, massage (which not every >7 year old has mastered). It’s odd for critics to almost demand that I only do TCM acupuncture so they can dismiss me as a quack. Fortunately my scope of practice allows me to do some other things as well.
    Would I go to acupuncture school today? No. Will I totally stop doing acupuncture tomorrow? No. Am I working on other options? Yes. If I stopped doing acupuncture, would people in my town get less acupuncture? No, they’d go to one of the other 5 or so acupuncturists who are much quackier than I am.

  25. Wow, Skeptical_Health, I think you should change your screen name because I see nothing healthy coming out your keyboard. Are you here to make skeptics look bad? That appears to be your true motive, as that’s what you are accomplishing. I’m not hiding behind anonymity here, my profile and blog link are real (http://www.ancientway.com/blog). I generally don’t censor blog comments, though if you swear or use demeaning sexual imagery I will.
    The high point of my blogging year so far was having comments posted by James Randi on my post about his trip to China, here: http://ancientway.com/blog/?p=2416. I e-mailed him at his randi.org address and we had a nice exchange. He, too, criticized acupuncture, but in a much more polite manner. The Amazing Randi also seemed to get it, like PMoran (thanks) that I am not his enemy.

  26. Oh my god, quit plugging your crappy accuquackery blog.

  27. P.S. How does it feel to be pracitcing “TCM”, and yet the majority of your quackery was made up on the spot, out of thin air?

  28. Oh, and if you want to keep calling yourself “skeptical accupuncturist”, why don’t you link high quality rigorous systematic reviews that demonstrate unequivocally the efficacy of accupuncture for the reasons you previously posted. I think accupuncture is a stupider form of quackery than chiropractic, but chiropractic is infinitely more dangerous.

  29. And I apologize to anyone reading, but I cannot be kind and pander to a-holes who rob the sick blind.

  30. nybgrus says:

    better to not be a dick in the first place, than apologize for being one.

    Doesn’t really bother me, personally. I’ve read and seen (and said) much worse things in my day. It’s just genuinely pointless is all. I understand that these people are indeed quacks. And I agree that despite him being much more amenable and open minded that most sCAMsters, SA still is hanging onto and practicing quackery. I view him as the pleasant but sleazy car salesman happy to sell you a lemon because it will make you happy in the short term and line his pocket in the meantime. But such vehemence and abuse truly just doesn’t serve any purpose… except perhaps attempting to felate yourself. And we all know how that can end up (NSFW language)

  31. Scott says:

    There is a difference between “be kind and pander” and “be civil.” The latter has little downside in general.

  32. Ben Kavoussi says:

    I’ll bet the vast majority of state legislators who made acupuncture and oriental medicine a licensed health care practice had no idea that they were legalizing superstition, magic, astrology, sorcery and demonology.

    This is absolutely true. What is more interested is who is behind these legislative initiatives — because it is certainly not the Asian community in the US. Asian immigrants in US are amongst the most educated communities and in general have a pro-science and technology approach.

    There are 2 main forces behind this “regulation of nonsense:”

    1- The American Association of Acupuncture and Oriental Medicine (AAAOM): an advocacy group that promotes New Age mambo-jumbo under the label of “Oriental medicine.” If you look at the background of its leadership, none has any real education in biomedical sciences.

    http://www.aaaomonline.org/?page=Directors

    2- The American Acupuncture Council (www.acupuncturecouncil.com). This is a provider of acupuncture malpractice insurance in the US. This insurance company has intimate ties with the trade journal
    Acupuncture Today (www.acupuncturetoday.com), and is politically very active.

    As for the absurdity of acupuncturists as primary care providers, we have made some significant progress in California. A few months ago, the State Senate Senate Business, Professions and Economic Development Committee harshly criticized the Acupuncture Board of California during its sunset review. One of the criticisms was the primary care issue:

    “Both the [Little Hoover Commission] and Legislative Counsel did not believe that the law creating the Acupuncture Act intended for an acupuncturist to be the primary care professional responsible for coordinating (or being the “gatekeeper”) for the ultimate care of a patient.

    As the Little Hoover Commission indicated:

    “While some people may turn to acupuncturists first for everything that ails them … it is difficult to see how practitioners of an alternative healing paradigm can be responsible for coordinating care with biomedical specialists (another potential meaning).” (Little Hoover Commission, Regulation of Acupuncture: A Complementary Therapy Framework, page 25.)”

    Currently, the California Acupuncture Board is given to clean up the mess created by the industry insiders who have staffed and run the Board since its inception. Hopefully, the Senate Senate will soon shut down this nest of quackery and puts an end to the legislation of superstition and ignorance!

  33. Thomas says:

    I think post-modernism is one issue, but libertarianism light is another issue. In my mind they are twin sides of an ideological coin. The left likes post-modernism–everything is relative–and the right likes the–all personal choice is relative. One is external relativism and the other is internal relativism. They are both wrong.

    In terms of accupuncture, I’ve noticed they glom onto every trend and entrench themselves there. I’ve seen this is in the Paleo and low-carb movement in terms of both accupuncture and chiropractors. In particular this individual is well viewed by the “War on Insulin” blogger Peter Attia, who works closely with Gary Taubes, and various paleo sites such as Robb Wolf.

    Here is a link to the biggest offender, Chris Kresser, LLc. and some reviews of his site:

    chriskresser.com

    http://paleohacks.com/questions/107178/tell-me-about-your-personal-experience-with-chris-kresser#axzz25sgEX2ov

    He charges 250 dollars an hour for webcam and phone consultations, which end in prescribing expensive supplements.

  34. jmcohen87 says:

    “We know acupuncture doesn’t work.” We may need to reevaluate what we know.

    I’m waiting to see how SBM will spin this to accord with their preconceived biases.

    http://archinte.jamanetwork.com/article.aspx?articleid=1357513

    http://well.blogs.nytimes.com/2012/09/11/acupuncture-provides-true-pain-relief-in-study/

  35. lilady says:

    @ jmcohen: The *researchers* of that study did a meta-analysis of prior studies, but *improved* the limitations of meta analyses by contacting the authors of each of what they considered *the best* of the many studies that they reviewed.

    Neither of your links to articles, referred to the actual NCCAM statement and opinion of the study.

    http://nccam.nih.gov/research/results/spotlight/091012

    Did you happen to miss this from the NCCAM-sponsored study? How would this statement about the “larger component” affect the result of the meta-analysis?

    “A recent NCCAM-funded study, employing individual patient data meta-analyses and published in the Archives of Internal Medicine, provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain. In addition, results from the study provide robust evidence that the effects of acupuncture on pain are attributable to two components. The larger component includes factors such as the patient’s belief that treatment will be effective, as well as placebo and other context effects. A smaller acupuncture-specific component involves such issues as the locations of specific needling points or depth of needling…..”

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