[...] stula) between the aorta and the intestine (resulting in death). Other adverse e [...]…

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…..”

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/

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.

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!

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)

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.

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