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James Reston’s Tooth of Gold

One of the fathers of critical thinking and skeptical inquiry, the French philosopher Bernard le Bovier de Fontenelle (1657–1757) recounts in 1687 in his Histoire des oracles–a debunking book on popular beliefs, myths and superstitions that caused tremendous stir in theological and philosophical circles of his time–a colorful story that could very well illustrate the flurry of interest and research in acupuncture that followed a 1971 anecdotal account of its use in China, and the plethora of verbiage and publications that ensued. If the story of the Tooth of Gold is comical, colorful and amusing, its applicability to acupuncture is not.

In 1593, the rumor ran that a seven year old in Silesia grew a tooth of gold in place of one of the cheek tooth he lost. Horatius, professor of medicine at the University of Helmstad, wrote a history of this tooth in 1595 and alleged that it was partially natural, partially miraculous, and that it was sent by God to this child to console the Christians that were oppressed by the Turks. Just imagine what consolation and what concern this tooth might bring to the Christians or to the Turks. For this tooth not to lack historians, Rullandus rewrote its history in the same year. Two years later, Ingolsteterus, another learned man, wrote against the views of Rullandus on the tooth of gold; to which Rullandus immediately wrote a fine and wise reply. Another great man named Libavius gathered all that had been written on this tooth and added his own views. Nothing lacked to these many fine books, other than the tooth were truly of gold. When the goldsmith examined it, he found that it was made of a leaf of gold skillfully applied to the tooth; but they began by writing books and then they consulted the goldsmith.1

Translated from French by the author

Besides the glut of popular publications on Chinese acupuncture and medicine by wishful authors without any training in biomedical sciences and healthcare, the NIH, the NCCAM, and some of our most prodigious medical universities also have official and academic publications on the subject that too well resemble the fine and wise publications of Horatius and his contemporaries. They also began by writing books and articles on the theories that could explain the purported indications of acupuncture, and then they assessed the veracity these indications in clinical trials and according to the principles of evidence-based medicine.

The rumor ran this time in 1971, when James Reston, a journalist in President Nixon’s press corps, reported in an article in The New York Times to have experienced relief by acupuncture for his postoperative abdominal distension. Within the following months, journalists, scientists and physicians made pilgrimages to China, most reporting in the popular press, and a few in scientific journals, that thousands of successful operations were being carried out in PRC using acupuncture anesthesia; some described its use for a host of conditions; other went as far as claiming its miraculous efficacy for treating paralysis and deafness!2

For acupuncture not to lack authors and historians, many holistic health gurus who did not have any knowledge of the history of medicine in China or in the West; who lacked familiarity with the Chinese language and cultural linguistics; and who have never–or, at best, for short periods–been to China,3 also turned their Countercultural fantasies about the “Mythical Orient” into a series of introductory books on the “Foundation of Chinese Medicine,” or on “Understanding Chinese Medicine” and portrayed a set of astrology-based beliefs that throughout the history of China have been associated with astral magic, amulets and talismans, and frowned upon by the leaned physicians,4 as gentle, humane, natural, organic, holistic and patient-centered therapies that are free from the constraints of the so-called repressive rationality of industrialized medicine. Certain went as far as associating the health and safety mythologie of Bronze-Age China with emergentism and naturalism, and metaphorically described them as a “Web That Has No Weaver.”

Meanwhile, numerous clinical trials were also initiated, often poorly-conducted and biased, and their results too often suggested that acupuncture is effective for a surprisingly wide range of conditions.5 Finally in 1997, the NIH resorted to a panel of scientists and experts, “to provide health care providers, patients, and the general public with a responsible assessment of the use and effectiveness of acupuncture for a variety of conditions.” In the published Consensus Statement that gathered their views, the NIH claimed that there is “clear evidence” that needle acupuncture is effective for a long list of conditions and perhaps beneficial for many others.6

In the sobering decade that followed, systematic reviews of literature, notably one by Howard H. Moffet of Kaiser Permanente Division of Research, indicated that although acupuncture can affect outcomes and is distinguishable from a placebo, trials that compare distinct needling regimens often do not indicate statistically significant differences in outcomes. Indeed, the dominant scientific rationale for acupuncture involves the release of neurochemicals (such as endorphins) by the irritation and injury it causes, but there is little evidence that this release depends on any specific points or means of stimulation. Therefore, traditional theories for selecting points and stimulation methods appear to be unreliable for creating distinct regimens in clinical trials. Furthermore, since the difference between “real’’ and “sham” (control) treatments has not been clearly demonstrated, Moffet’s review concluded that most acupuncture clinical trials lack any scientific rationale to justify any specific regimens, and  that the theoretical basis and logic for acupuncture practice and research need to be re-evaluated.7

A most recent, as-yet-unpublished NIH-sponsored three-arm trial on chronic back pain also seems to confirm these conclusions. The subjects received either an individualized regimen according to the traditional acupuncture theories, or a standardized regimen, or sham (control) needling. Results demonstrate that acupuncture added to usual care was superior to usual care alone, but different regimens were not more effective than control needling.8 These results indicate that the observed actions of acupuncture are either due to the placebo effect, or to the irritation and injury caused by the insertion of a needle, and they in fact are independant of the traditional theories for selecting points and stimulation methods.

Deplorably, these results also indicate that in an era when pharmacogenomics and therapeutic cloning appear to be not-too-distant possibilities, medical inquiry and publication can still be based on rumor and hearsay in the press and in the popular culture, and lead to much illusory verbiage before scientific rigor and skeptical inquiry could assess their veracity, just as it happened about 500 years go, in 1593!

REFERENCES:

  1. Fontenelle BLB (Author), Bergier J (Editor). Fontenelle: Entretiens sur la Pluralité des Mondes suivi de Histoire des Oracles. Marabout Université. 1973. 
  2. Reisser PC, Reisser TK, Weldon J. New Age Medicine: A Christian Perspective on Holistic Health. Intervarsity Press. 1988.
  3. Bauer M. An Interview With Dr. Paul Unschuld, Acupuncture Today. July, 2004, Vol. 05, Issue 07.
  4. Barnes LL. Needles, Herbs, Gods, and Ghosts: China, Healing, and the West to 1848. Harvard University Press. 2005
  5. Ernst E. The recent history of acupuncture. Am J Med. 2008 Dec;121(12):1027-8.
  6. National Institutes of Health. Acupuncture. NIH Consensus Statement. 1997;15(5):1-34.
  7. Moffet HH. Traditional acupuncture theories yield null outcomes: a systematic review of clinical trials. J Clin Epidemiol. 2008 Aug;61(8):741-7. Epub 2008 Jun 6.
  8. Low-back pain: NACCAM Symposium features two researchers. Focus Complement Alt Ther. 2007;XIV(4):4-6.

Posted in: Acupuncture, History, Science and the Media

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47 thoughts on “James Reston’s Tooth of Gold

  1. twaza says:

    “These results indicate that the observed actions of acupuncture are either due to the placebo effect, or to the irritation and injury caused by the insertion of a needle …”

    There is a third and at least as plausible possibility: the observed actions of acupuncture are due to biased outcome measurements.

  2. JamesG says:

    James Reston was more than “a journalist in President Nixon’s press corps”.

    He was the ultimate Washington insider who wrote for many years a highly influential political column for the New York Times.

    This obituary gives some idea of his stature and why his report on acupuncture had such an enormous impact:

    http://www.nytimes.com/1995/12/08/us/james-reston-for-many-years-a-nonpareil-among-american-journalistsdies-at-86.html?scp=7&sq=reston%20acupuncture&st=cse

  3. Ben Kavoussi says:

    Indeed, you are absolutely right; there is a third possibility. I am planning to write a post on the plausibility of this explanation soon.

    Besides, Dwight Nance of US Irvine has also noticed by working with rat models that you cannot objectively compare an animal that is in the cage with an animal that you are holding and needling. To be accurate in the measurements of the effect, you have to compare it with another one that you are holding without needling, because the touching and holding already elicit an hormonal response, which could be seen as the “placebo” effect, even in animals. If I recall well, in fact, Dwight has measured the hind paw response to pain in these 3 different settings, and observed a gradual effect.

    Therefore, the observed effect of acupuncture is partially due to the care and the touch and the dialogue, if any–all of which constitute various aspects the placebo effect. I am certain that the same phenomenon is observable in human subjects.

    In this case, it would not be truly “biased outcome measurements,” but the erroneous experimentation methodology that needs to be addressed.

  4. A quick response. Between patients.

    I would encourage anyone who wants to get a crash-course on acupuncture research to read the following interview with Dr. Bruce Pomeranz the neuroscientist who first discovered that acupuncture can trigger endorphins. http://www.medicalacupuncture.org/acu_info/interviews/pomeranzart.html

    In this interview, he explains that his research team investigated 16 different lines of evidence trying to disprove the endorphin hypothesis making this a far more proven claim than the vast majority of what goes on in science based medicine. Most (if not all) of this research was done on animals including anesthetized animals to completely rule out the placebo effect.

    Contrary to what Ben believes, Dr. Pomeranz found that the points do matter in eliciting the endorphin response but this is based on the specific nerves being stimulated. You will also read that he was conducting research that was showing a 50% improvement in wound healing rates that has nothing to do with endorphins. The reason acupuncture can speed wound healing is that it helps the body to do a better job of utilizing its own self-healing resources. That is why it has the POTENTIAL to treat such a very wide range of conditions. I like to say that a course of acupuncture treatments, given by one who knows what they are doing, should constantly be able to help give the patient’s system at least 10%-20% boost of its self-healing resources. If that boost makes the critical difference, the treatment is a success, if not it fails. The problem in researching this claim is that the body’s self-healing mechanisms are so incredibly complex the only way we could know what acupuncture does is to first know everything about how the body heals/manages itself and we don’t even know the tip of that iceberg.

    Ben raises valid points about how Chinese medicine was romanticized by Westerners that had little knowledge of the complex historic facts behind this medical system. I had such notions myself 30 years ago when I was first introduced to Chinese medicine but soon after I became a student of a man that had a vast knowledge of Chinese written and oral folk history. It was through my many years of study with that man and then familiarizing myself with some of the modern historians’ understanding that I began to get the bigger picture of the roots of Chinese medicine. And I hate to say this Ben, but without a deep understanding of Taoist philosophy and folk history, your knowledge is quite shallow.

    You may be surprised to learn I partly agree with Howard Moffett that traditional theories about acupuncture need to be reevaluated. We live in a new age with the ability to not only look back on the history of one culture but to learn of how acupuncture was spread throughout the entire Far East and now throughout the world. While this reevaluation is going on however, the traditional theories are still serving those in need quite well. Those who don’t believe that have no knowledge of just how safe and effective acupuncture is in the real world.

  5. Ben Kavoussi says:

    Here’s the original story in French:

    La Dent d’Or

    En 1593, le bruit courut que les dents étant tombées à un enfant de Silésie, âgé de sept ans, il lui en était venu une d’or, à la place d’une de ses grosses dents. Horatius, professeur en médecine à l’université de Helmstad, écrivit, en 1595; l’histoire de cette dent, et prétendit qu’elle était en partie naturelle, en partie miraculeuse, et qu’elle avait été envoyée de Dieu à cet enfant pour consoler les chrétiens affligés par les Turcs Figurez-vous quelle consolation, et quel rapport de cette dent aux chrétiens, et aux Turcs En la même année, afin que cette dent d’or ne manquât pas d’historiens, Rullandus en écrit encore l’histoire Deux ans après, Ingolsteterus, autre savant, écrit contre le sentiment que Rullandus avait de la dent d’or, et Rullandus fait aussitôt une belle et docte réplique. Un autre grand homme, nommé Libavius, ramasse tout ce qui avait été dit sur la dent, et y ajoute son sentiment particulier. Il ne manquait autre chose à tant de beaux ouvrages, sinon qu’il fût vrai que la dent était d’or Quand un orfèvre l’eût examinée, il se trouva que c’était une feuille d’or appliquée à la dent avec beaucoup d’adresse; mais on commença par faire des livres, et puis on consulta l’orfèvre.

    Bernard le Bovier de Fontenelle

  6. sstumpf says:

    Mr. Bauer should get a hold of E. Barker Bausell’s book “Snake Oil Science: the Truth about Complementary and Alternative Medicine”. I read the 1996 Pomeranz interview with great interest. Thanks for the link. I noted he also states he has never found chi and that the original number of meridians had to be consistent with the zodiac so a 12th was “discovered”.

    I read the interview a bit differently probably because I have read Bausell’s book which is pretty much devoted to examining the placebo effect. Pomeranz reinforces the widely accepted “scientific” medical interpretation of how needling therapy works (at least it is widely accepted among “science based medicine” folks). References made by Pomeranz to Taoist philosophy are no more primary than references made to the zodiac. The issue with TCM has to do with clinging to a perfectly silly approach to medicine as though it were based in fact or, god forbid, science. Isn’t Pomeranz reinforcing what many others from White to Ma to Kendall to Schnorrenberger (and others) have advocated? Needling works just fine without the TCM magic or Taoism. Not that religious beliefs are not helpful for the well-being of many persons and cultures. But that is the field of cultural anthropology.

    As for placebo research, Bausell makes several important distinctions. First, he does not dispute that needling therapy works. He only asserts that while research models capably distinguish between control and treatment groups they do not distinguish between treatment and placebo groups. He reasonably proposes that future needling research should therefore include a placebo group as a control.

    I also think Bauer did not hate telling Ben he needs to understand Taosim to appreciate TCM. I think he loved writing that! Please read Volker Scheid, a cultural anthropologist who studied Chinese Medicine in China for 8 years, before posting again! OK. I loved writing that!

  7. pmoran says:

    ” I like to say that a course of acupuncture treatments, given by one who knows what they are doing, should constantly be able to help give the patient’s system at least 10%-20% boost of its self-healing resources.”

    Can you explain how you know this? Bear in mind that we would expect any good hands-on placebo to be associated with results something like this, or better, with the kind of conditions for which acupuncture is commonly used.

    You do know that other placebos have been reported to have endorphin and other types of neurochemical activity? This is not unique to acupuncture.

    It is difficult to respond to third-hand references to studies supposedly showing non-placebo, non-irritant, effects of acupuncture. Those studies would need very careful examination, as well as consistent replication, before they can influence opinion much.

  8. Manduca says:

    What are self-healing resources? How does one measure them? What does it mean to boost them 10% to 20%?

  9. I was asked several very good and constructive questions based on my last post. I am very happy to answer them although I am slammed with patients so I am going to give a few fairly short answers that hopefully will capture the gist but not give the detail the subject may deserve. Perhaps I can fill-in those details later.

    I was asked how my claim that a good series of acupuncture treatments should consistently boost the body’s self-healing resources 10% – 20%. On one scale of course I don’t “know” this because how can anyone “know” anything with 100% certainty? That out of the way – the short answer is Occam’s razor: it is the only explanation that makes sense when one considers what is observed with acupuncture’s clinical effects. The problem most of you have with this answer is that you are not familiar with what occurs when treating thousands of people over time with acupuncture.

    While I know that no single case can “prove” anything beyond a doubt, let me share one case that raises many doubts about the placebo hypothesis. This patient is actually on my treatment table as I write this with needles in her. She is an 83 year old Caucasian female who was diagnosed with macular degeneration 5 years ago. Before this diagnosis she had seen me a few years pervious for sciatica which responded well to treatment but would occasionally flair-up so she would return for a shorter series of a few tx to know the flair-up down. About 1 year after she had been diagnosed with macular degeneration, she asked me if acupuncture could help. I told her that treating degenerative conditions (her vision was deteriorating steadily) is always difficult because the boost acupuncture gives the body’s self healing/management resources may not be enough to make any difference but we ahead and proceeded with treatment.

    Within three months her vision had improved so that she was able to see an additional line on the vision chart and improved steadily to where she eventually improved to making out three additional lines on the vision chart according to her optometrist (who by the way told her acupuncture was a waste of time. He now tells her whatever you are doing is working and he is a “believer” in acupuncture).

    But here is the kicker. During one visit, this patient told me that she had noticed a few time that when she came in for a treatment (at this point I was seeing her once every 2 weeks) she could not read my name which is embroidered in script on my work shirt, but she was able to make it out just fine after treatment. Tell me how placebo explains that.

    Also, while she was seeing me for (successful) management of her sciatica, it did nothing for her vision. It was not until I changed her treatment to address the vision that it improved. If it does not matter where you put the points, why would that happen? Another thing that she just reminded me of: She had never informed me that she suffered from migraine headaches for many years and these also did not improve while I was treating her sciatica but they did stop after a few months of the treatment I did for her vision because many of the points I was using for that CAN also be effective for migraine.

    Again, I know any one case can be picked apart and any number of explanations can be offered-up to discount that my treatments of this woman prove acupuncture has real, beyond placebo effects. But, just as Pomeranz did 16 different line of evidence for the endorphin hypothesis, this above patient is just one of dozens, even hundreds I could cite that make the placebo hypothesis less and less likely as you add them all up.

    Watch it in practice on dozens of conditions and hundreds of people and add that to the mix of studies before reaching conclusions. Gotta go now but I look forward to sharing more.

  10. Scott says:

    Coincidence is always a strong possibility. Without the rigorous studies there is no way to tell what’s an effect of the treatment, and what would have happened anyway.

    When all the rigorous evidence points one way, a smaller amount of less rigorous evidence does not provide any justification for rethinking the conclusion. Cherry-picked anecdotes simply are not convincing evidence.

  11. daedalus2u says:

    One part of the physiological placebo effect is the triggering of the neurogenic release of NO. In the case of macular degeneration, that NO causes vasodilation and can cause acute improvements in blood flow to the retina. Higher NO in the brain can also improve signal processing by allowing the recruitment of larger brain volumes for processing by increasing the functional connectivity. That NO also can cause vasodilation in the brain and improve migraine acutely. There are also systemic effects that take longer.

    If your patient thought she was getting a big benefit that alone is enough to trigger a placebo effect. Naltrexone attenuates the physiological placebo effect for some things. Presumably those things are mediated through pathways that are blocked by naltrexone. Endorphins cause the release of NO. Some of the pathways blocked by naltrexone do cause the release of NO.

    There is nothing in the anecdote you give that supports a non-placebo mechanism for acupuncture.

  12. I knew and stated that any one case does not prove anything. But I must say – if your idea of a placebo is that is causes brain and body chemistry changes that can help repair the cause of organic disease – then I am fine with calling acupuncture a placebo. But let’s be clear that it is the most spectacularly successful placebo in history and that it is safe and works in a very wide range of people for a very wide range of disorders. I don’t know how many physicians could successfully treat sciatica, migraines, and macular degeneration in a single elderly person with no side effects but, if so – great. You do it your way, let me do it mine. I would like to add the following that may relate to the placebo hypothesis.

    The critical issue with acupuncture that is not given the consideration it deserves is that acupuncture helps the body to repair/better manage itself. That such a thing is possible is rarely, if ever even considered in modern medicine. In essence, modern medicine looks at the body like a complex machine and the physician is like a mechanic that tries to understand what is dysfunctional within the machine and then tries to repair it with outside resources such as chemical, surgical, radiological, or physical manipulation. With this approach great things have been accomplished in medicine and this is a very valuable approach and a monumental accomplishment of modern science and the mechanical model of nature modern science sprang from.

    But, unlike any machine, living systems – including human organisms – have the capacity to self-repair or maintain homeostasis. Living systems are constantly monitoring themselves and making adjustments based on the status reports received throughout the system and then making complex adjustments based on those reports. This system does not always operate at its most efficient level – just because a health problem lingers does not mean it is beyond the system’s ability to repair itself. This is something modern medicine has largely (but not completely) overlooked. We don’t always get 100% out of our self-repair/management capacity anymore than we do out of our brain capacity or muscle capacity. When acupuncture is effective, it is because it helps the body to get closer to 100% of its self-repair capacity. If the extra capacity (that I estimate as a 10%-20% boost) is enough to tip the scales and help the body’s resources get the upper hand in this struggle, the treatment is successful. Unlike mechanical medicine however, acupuncture cannot be effective for problems the body never had the capacity to repair in the first place.

    There are then, two primary methods we can approach any health problem; one way is we try to repair problems with outside resources like a mechanic, the other is we try to goose the body’s systems in an attempt to help it better utilize its own resources – what my teacher calls “using nature to help nature.” I have theorized that these two approaches both have their strengths and weakness that happen to be the mirror opposites or each other – the strength of one is the weakness of the other and vise versa. I am not saying one approach is better than the other, just that they are different. Unfortunately most “authorities” do not even realize that the “using nature to help nature” approach is something that one can build an entire medical system around but acupuncture is just such a system. The problem with modern acupuncture research is that it uses a system that was refined to investigate the mechanical approach and so it is not well suited to investigations into what can be accomplished with the “nature helping nature” approach.

    Now, I know that last statement especially will upset many who think there is only one science and one way to investigate a hypothesis but let me give you an analogy – a sort of thought experiment to give you an idea of what I am talking about:

    Imagine taking a feather and lightly touching someone in a specific spot under their nose with it and causing them to sneeze. Now touch the same spot in other test subjects. You might find that only 20%-30% at most will also be triggered into a sneeze. Does that mean the sneeze was a placebo? Most critical thinkers I believe would assume not. Most would assume that touching this spot has the POTENTIAL to trigger a chain reaction – a domino effect – if you will, that CAN result in a sneeze. The first domino to fall is when you lightly touch some skin cells and stimulate a specific bunch or nerves and the last domino is the sneeze. But the reason knocking over the first domino does not cause everyone to sneeze is because in order to reach that last domino, several other middle dominos need to be lined-up just so and these middle dominos – like so much with the human living system – are in a constant state of flux. So causing a sneeze by touching with a feather is not such an easy mechanical thing. You may well find that even when you cause one person to sneeze, you may not be able to cause that same person to sneeze later touching the exact same way because of those middle dominos.

    Now – design a double-blind controlled clinical trail to determine if it is in fact possible to cause subjects to sneeze by touching them under their nose with a feather. Remember that one of the most important factors you must demonstrate to satisfy current scientific protocols is a high degree of reproducibility and you must also explain the exact mechanisms of the phenomenon. Every domino. In addition, since there is no real money to made if you should in fact prove this is a real physiologic possibility, there will be very little money to do research and those most experienced in feather-tickling have no scientific training so most of the best designed trials will ignore those with this experience and lessen the chances for causing sneezes. On top of that, there is an active movement of skeptics that believe causing people to sneeze this way is a sham and a danger to the public so any research you produce will be pounced on by them and they will keep moving the goalpost while demanding a stop to it all.

    Acupuncture is even more complex than causing someone to sneeze with a feather because we are trying to trigger myriad body self-healing reactions not a singular thing like a feather or even endorphins and because acupuncture has traditionally been based in the dynamics of qi a phenomenon that cannot be proved or disproved.

  13. daedalus2u says:

    You make an interesting (and I think true) statement “acupuncture has traditionally been based in the dynamics of qi a phenomenon that cannot be proved or disproved”.

    The phenomenon of qi was never provable or disprovable. When the concept was invented millennia ago, those who invented it could not prove or disprove it. They simply made it up without enough knowledge or evidence to prove or disprove it. We have access to every bit of knowledge (and vast amounts more) that the ancient inventor of acupuncture did, and we know that the fundamental concept can’t be proven.

    The concept of qi is incompatible with much that we are quite confident about, the conservation of mass/energy, no action at a distance, no anatomical structures at the traditional meridians, and so on. Why should we continue to use the concept of qi when it has no explanatory power and has no known physical basis?

    What ever the physiology behind acupuncture, it could not have evolved to be specific to acupuncture. Many humans are descended from ethnic groups that never used acupuncture. If acupuncture does work, then it somehow taps into some other common pathway that other “traditional” non-pharmacological and non-surgical techniques tap into. I call that common pathway the physiological placebo effect. Is acupuncture “the best” way to invoke the physiological placebo effect? No, it isn’t. It uses needles that pierce the skin and so present a risk of infection, nerve and vessel injury. Sham acupuncture appears in some cases to work better, I suspect because the skin is not pierced and so there isn’t the pain which can trigger the “fight or flight” state which is (by my understanding) incompatible with the placebo effect. I think that is why toothpick work better than needles for acupuncture.

    For virtually all basic research there is no money to be made on it. In the other study that was talked about, the carbohydrate-diet study, who can make money off of that? Maybe suppliers of carbohydrate, but there is no “Big Carbohydrate” monolithic carbohydrate industry set to make money off of changes in diet.

    There is money to be made in acupuncture, and acupuncturists are making it. They would make less money if acupuncture was understood to be “just a placebo”. It is understandable why they don’t want to come to that understanding no matter what the research says. Acupuncturists don’t want to understand what the physiology is behind what they are doing.

  14. “We have access to every bit of knowledge (and vast amounts more) that the ancient inventor of acupuncture did, and we know that the fundamental concept can’t be proven.”

    This is a common fallacy of Western culture – the idea that we continually maintain and then add to the knowledge of previous generations. This idea is not even always true for technological knowledge let alone non-technical knowledge. While we have theories, the technical knowledge of how the ancient Egyptians built the pyramids was lost to later generations and the possible deeper spiritual aspects of those efforts are completely lost. The Chinese built the world’s first mechanical clock then forgot all about it.

    This is the great difference between Western and Chinese culture, the Chinese of more than 2,000 years ago deeply believed that the greatest wisdom humans had obtained was discovered by ancient Sages long before recorded history. Traditional Chinese culture looked back, the West looks forward.

    In my studies of Taoist folk history, I learned that some Taoist trace their roots back tens of thousands of years. Modern humans, Homo Sapiens Sapiens, have roamed this earth for 200,000 years and as the lone hominoid species for around 40,000 years. These were modern humans with modern brains as intelligent as anyone today but all we know of there knowledge is some of the technical knowledge of their stone tools. Do you think it is at least possible that these modern humans gained some useful knowledge that has since been lost? Not technical knowledge perhaps but some wisdom of nature and humankinds place within it? That is what the Taoist believed and they claimed to have passed this wisdom down while it was lost to the rest of humanity including the knowledge of how to manipulate sore spots to restore health.

    Ancient Taoist legend states that their early ancestors noticed people developed tiny tender spots in their muscles that seemed to come and go with illness. They learned how to manipulate these spots with their hands and then later began to use needles in addition to their hands. By manipulating these spots, the illness improved better than if the spots were not manipulated. This makes perfect sense as skilled acupressurists and some acupuncturists will agree than such tender spots can be observed to come and go will disorders. It was only much later when the idea of organizing society under astronomical patterns arose that some of the many hundreds of therapeutic sore spots were organized into 365 spots along 14 qi pathways. Unfortunately, most of the knowledge of these early roots were lost except to a few secretive oral traditions.

    If this is correct which I believe it is based on my work with sore spots, this would mean that the roots of acupuncture were empiric, refined over long trial and error observation and was only formalized much later under the current scheme. Why does rubbing a boo-boo make it feel better. Is it placebo or does this trigger a complex range of physical, neurochemical reactions like the feather causing a sneeze I mentioned. Perhaps other cultures also developed similar knowledge of manipulating sore spots but it was lost over time like the knowledge of how to build pyramids. Some claim the in India the Ayurevedic medical system had acupuncture (they claim before the Chinese) but lost it.

    It is insightful to learn that the ancient Taoist warned against the overuse of technology as this held the risk of further separating humans from awareness of the patterns and cycles of nature which all life was dependant. Lao Tzu (500 B.C.) warned that will the future would bring many useful new inventions but “things of temporal convenience will bring hidden troubles later” (The Hua-Hu Ching.)

    You might wonder what “wisdom” could primitive people had had 10,000 year ago to compare to today’s technological knowledge? Well, the jury is still out. We may yet destroy all possibility of future life with our technological knowledge. This would be an impressive technological achievement but would that be wise?

    The real issue with the question of Taoist knowledge has to do with spirituality. Modern science was born out of a compromise with the Catholic Church that science would steer clear of questions of spirituality and deal only with matters of the material realm. Taoist science did not make such a deal. They sought to understand both the material and the spiritual realms and stressed that humans were best off when they struck a balance between the two. That is what the original concept of the balance of yin and yang was all about but this, like much in Chinese prehistory was largely lost by the time of recorded history.

    Of course, maybe the ancient Taoist were wrong and maybe the only useful knowledge our prehistoric ancestors left us was things like the use of fire and stone tools that we could build on to eventually threaten our very existence. Or maybe they were right and they learned deep insights regarding how all life is interconnected in a manner similar to how hidden sore spots are interconnected to bodily processes.

  15. pmoran says:

    I agree with Daesalus2. qi has no validity as a scientific hypothesis as it is not a necessary explanation for anything.

    That acupuncture helps mobilise unspecified “self-healing” processes is a more reasonable conjecture, so long as you use the word healing in the broadest sense allowing it to include various types of placebo responses. There is not yet any liklehood that it mobilises any other form of healing in any non-trivial way.

    We can be certain that you are overestimating the “healing” power of your methods, because everyone does. Your example case, which we can assume is typical and among the best you’ve got, almost certainly exemplifies the main processes involved.

    Sciatica usually gets better by itself.

    Migraine is placebo responsive.

    Patients are eager to please their favorite practitioners and will try very very hard to find improvements even if the treatment has little or no effect.

    Practitioners need self-validation and are not inclined to learn from the parable of the gold tooth. You accepted the patient’s account of the improvement in vision but did you ask the goldsmith/opthalmologist whether the optic disc was looking better or worse?

    Nevertheless acupuncture is a good placebo. We don’t yet know for sure whether that enables it to be a reasonably cost-effective resort for patients with some conditions. We do need to keep our eyes open as to the why it seems to “work”.

  16. Ben Kavoussi says:

    Dr. Moran, Barker Bausell in Snake Oil Science also points out to the fact that most acupuncture studies do not take the natural history of the disease in consideration. Depending on when you intervene and measure, you will get results, due to the natural history of the healing process.

  17. Ben Kavoussi says:

    Dear Mathew,

    I don’t know if you realize this or not, but the ideas you develop and advocate in detail in your posts are the same exacts notions that most authors in this website, including me, are eager to see being eradicated from healthcare practice, legislation and education. They all fall under the category of wishful thinking, dream and fantasy.

    As for Taoism (Daoism), please realize that was cited by the US supreme court as a “religion” in Torcaso v. Watkins, 367 U.S. 488 (1961), page 495 footnote 11.

    Every line you have written here confirms the obstinate devotion of acupuncture practitioner-advocates to the theories that emanate from China’s religious and mythological past, and which have all the characteristics of what is called “willful ignorance,” meaning the intentional and blatant avoidance, disregard or disagreement with facts, empirical evidence and well-founded arguments, for they oppose or contradict your own personal beliefs…

  18. “As for Taoism (Daoism), please realize that was cited by the US supreme court as a “religion” in Torcaso v. Watkins, 367 U.S. 488 (1961), page 495 footnote 11.”

    Is that actually relevant? Taoism is taught in academic circles as both a philosophy and religion. One can be practicing one or the other or both and there isn’t really a conflict. The Supreme Court also specified Secular Humanism as a “religion” in the same breath, yet it’s commonly taught as a philosophy (not a religion) that rejects all concepts of spiritualism and other mystical hoodoo.

    However, I do agree with you that any treatment that decides to end their research with just “well, I’ve seen it work, that’s good enoguh” and “ancient people that we believe had great wisdom said so – even if we have no current proof” isn’t sufficient and thus shouldn’t be given any more credibility than laying-on-of-hands, “miracle” healing, and psychic surgery. If accupuncture is as effective as proposed, there should be studies designed to prove it’s effectiveness in a scientifically observable manner.

    If accupuncture’s effectiveness were based on empirical observation refined over much trial and error, then it should be empirically verified (and reproduceable) via scientific method. If it can do so, then do so, and we can move on.

    And I personally apply the Taoist philosophy in my life and find it to be a rather worthwhile one to look into.* However, Taoist practicioners at one point thought ingesting mercury was a good idea. I would never claim that all Taoist ideas are wonderful. That’s where applying the centuries of reproduceable science (and reason) since Lao Tzu can be rather effective to prevent poisoning yourself. And later writers that have turned mercury (and lead) into a metaphor sounds more like apologist revisionism than anything else. They also believed that through Taoism some sages lived for over 1,000 years – yet there was never anything other than stories to back it up. So no more evidence for that than for fairies and werewolves.

    Something can produce worthwhile ideas/concepts without all of them being useful after reasonable review. That’s a primary concept in science as well as philosophy.

    * Neophytes to taoism might want to look into “The Tao Of Pooh” as an introduction to the philosophy instead of “the Hua-Hu Ching.”

  19. Ben has accused me of “willful ignorance” made it very clear he and others despise people like me. People in my healing field have had this sort of prejudice aimed against us from the very first days we came to public light in the West. It made some of us get angry and lash-out at the medical establishment and that just made matters worse. In an earlier post I suggested to Ben that this blog may not be the best forum to exchange views and I offered to send him a copy of my book and gave my email address so we might communicate in more depth because this is a subject that requires more than short blurbs. Ben declined to do this so I ask some indulgence here in allowing me to offer a somewhat lengthy post that will give a better idea of the cultural difference between Chinese and Western thinking. What you will see is that unlike the West, Chinese thinkers sought to bring critical thinking to both the physical AND spiritual aspects of life. While few may agree with this other way of thought, I hope you might at least acknowledge that far from willful ignorance, this represents a different perspective on what subjects can be studied in a methodical, experimental manner. The following is a short section of my book that examines the differences and similarities between western and Taoist science.

    A Tale of Two Sciences
    The roots of Western science stretch back to the ancient Greeks from around the period just before Christ. The Greeks popularized the idea of relying on logical deductive reasoning to understand nature and humankind’s place within it. Many of Western science’s basic principles were developed during this age, including the idea of relying on mathematics to unlock the mysteries of nature, and the concept of “atomism.” The term “atom” designates something that cannot be cut or that is indivisible; the atomic theory states that everything is made of a limited number of elementary particles or building blocks that join together in many different ways.
    Greek science and philosophy, absorbed by the Romans, helped build the vast Roman Empire. When it crumbled, the city of Rome itself sacked in 410 AD, the Catholic Church rose in power. The Church insisted that its interpretation of the Bible formed the basis of all necessary knowledge and Western science and technology took a giant step backward as Europe entered the Dark Ages.
    The great 17th century scientist Galileo, often referred to as the “Father” of Western science, started the idea of using experiments to prove the validity of scientific theories. Before his time, the forefathers of Western science believed you could use pure logic to reason out the truth, a practice accepted since the days of Aristotle, whose theories were held in the highest regard and, in fact, viewed as scientific laws.
    Galileo changed all that when he proved Aristotle’s theory about the motion of falling bodies to be wrong. Aristotle had reasoned that the heavier an object, the faster it fell to earth. Creating one of the first Western scientific experiments, Galileo dropped two balls of the same size but different weights off the Leaning Tower of Pisa; they hit the ground at the same time. The heavier ball did not fall faster. Galileo further proved this by carrying out a series of elegant experiments rolling balls down an inclined plane and carefully measuring their speed.
    Galileo’s method of using experiments to verify theories formed the backbone of what we in the West call the “scientific method.” In the 17th century, however, his ideas were socially unacceptable, especially his support of Copernican’s 1543 theory that the sun, not the earth, was the center of our system of planets, or solar system. For his public endorsement of the Copernican Theory, Galileo was denounced by the Catholic Church’s Inquisition. The Church declared the sun-centered theory not only “foolish and absurd,” but heretical, inasmuch as it “contradicts the teachings of many passages of Holy Scriptures.” (“Calendar” P.185 by David Ewing Duncan, Avon Books, Inc., 1998).
    Under threat of excommunication, the aging Galileo, a devote Catholic, recanted his beliefs about the planets revolving around the sun, and spent his last days under virtual house arrest. But his martyrdom by the Catholic Church only served to make him an inspiration to future Western scientists and assure that the scientific method of demonstrating a theory’s validity through experimental duplication would prevent any powerful individual or institution from manipulating knowledge based on belief alone.
    This left the Catholic Church with a problem. For centuries, the Church and supporters of Aristotle’s methods of logical philosophy had struggled over the authority of theology vs. science/philosophy. Advisors within the Church now understood that new inventions, such as the telescope, together with the scientific method of experimentation were beginning to uncover facts both impossible to dispute and at odds with the Church’s ideas. If the Church stuck to its guns and denounced these scientists, it would lose face and power once the scientists were later proven correct. If, on the other hand, the Church agreed with the claims of scientists whose ideas contradicted its doctrine, it also faced embarrassment.
    Over time, scientists and the Church worked out a compromise of sorts. Science would be free to investigate the realm of the physical universe without interference from the Church, provided the realm of spirituality remained solely within the Church’s authority. Western science went on to become the dominant authority on matters of the physical universe, but, remaining true to the theology vs. science/philosophy compromise, has never seriously turned its attention to investigate questions of spirituality. Whenever questions of spirituality are posed to scientists, they commonly respond that such matters are not within the “realm” of science, as they are matters of “faith.”
    Chinese Science
    Chinese science, in contrast, did not evolve with any such compromise. The ancient Chinese, like people all over the world going back for tens of thousands of years, were very interested in matters of spirituality as well as matters of the physical universe. Hence, the ancient Taoists merged their search for truth to include both the physical and spiritual realms, with the result that Chinese science developed different laws than those in the West. They even created a symbol for their unique scientific system to demonstrate the inclusion of both the physical and spiritual natures of the world:
    Known to many as the “Yin/Yang” symbol, this is really a kind of formula or symbolic equation that represents the most important laws of Chinese science. One such law, unique to Chinese science, is the “Law of Opposites,” which declares that everything, in all of creation, must have an opposite. Nothing can exist alone; all phenomena come in pairs of opposites. Hence, half the yin/yang symbol is white and half is black. Another law: not only is everything paired with an opposite, everything contains at least some of its opposite partner within itself, represented by the little white circle within the back half and the little black circle within the white half.
    According to oral folk history, the Law of Opposites was largely inspired by the ancient Chinese’ observations that all nature seems to come in pairs. For instance, there are two genders: male and female. People use two legs to walk and birds use two wings to fly. Each day is divided into daytime and nighttime dominated by the sun and moon, respectively. Left and right, hot and cold, creation and destruction, inhalation and exhalation, and so forth: the ancient Chinese sited countless examples of pairs of yin/yang opposites.
    While some might scoff at these examples constituting proof of a scientific law, Western science has itself been proving that law correct with its own recent discoveries. According to Western science, all material objects are composed of differing arrangements of the smallest possible building blocks, atoms, which were first detected in the early 20th century. Chinese science, however, does not allow for a “smallest possible” object because the divisions of yin/yang carry into infinity. Had Western scientists known this concept, they would not have been shocked when they learned that the atom, thought to be the smallest thing possible, was itself composed of smaller objects, the nucleus and electron, now known as “sub-atomic” particles. Scientists once again thought they had finally found the smallest indivisible building blocks of nature but the infinite divisibility of Yin/Yang was again supported when they discovered that at least one of the sub-atomic particles, the nucleus, is also composed of smaller components – neutrons and protons.
    The fact is that many of the most important discoveries of Western science support the Chinese science Law of Opposites, going back to Newton’s Third Law of Motion, “every action has an opposite and equal reaction.” Recently, we have learned that every particle has an “anti-particle.” All positive electronic charges are counterbalanced by negative charges. The atom’s sub-atomic particles are held in place by a delicate balance of centrifugal forces trying to rip the orbiting electron away from the nucleus and centripetal forces trying to suck the electron into the nucleus. The same sort of delicate balancing act is thought to be holding our universe together as the push of the Big Bang and pull of gravity provide a remarkably stable, although far from static, universe.
    Factoring in Spirit
    In Chinese science, the realm of spirituality is represented in the Yin/Yang symbol, confirmed by the Law of Opposites, and holds true across all levels of reality. On a small scale, the Yin/Yang symbol represents the relationship between tiny things, like sub-atomic particles. On a bigger scale, it denotes the relationship between visible paired phenomena such as male and female genders, or the sun and the moon. On the largest scale, it expresses the relationship between the physical realm and its logical opposite, the spiritual realm. Thus, a single law that predicts every known fact of our physical universe also predicts that an opposite reality — spirituality — must coexist with the physical realm. Like the black and white halves of the Yin/Yang Symbol, the two opposite realms of spirit and matter together comprise the whole of reality. The ancient Chinese felt no need to separate the study of the two, as has happened in the West.
    When I would explain all this to my patients or in group talks, I would encounter two distinct responses: some people would nod and be impressed that the ancient Chinese had come up with such a simple theory that explains so much, while the skeptics would point out I was talking philosophy, not science. The logical conclusion I presented — that the Law of Opposites’ validity for things in the physical realm proves the coexistence of a spiritual realm — was just a theory with no proof, they would say. And they were correct, in so much as what I have described so far about the relationship between the material and spiritual realms is more philosophy than science. But the fault lies not with the Law, but with my simplified explanation for the sake of brevity. You see, long before Galileo, the ancient Taoists had pioneered the concept of conducting experiments to validate their theories, including the Law of Opposites.
    The types of experiments the ancient Taoists carried out and duplicated over many successive generations differ by necessity from those conducted in Western science, because the experiments utilized in Western science were designed only for testing theories dealing with the physical realm. Testing the spiritual realm requires experimentation with a different version of the scientific method. To understand the Taoist scientific method, however, requires introduction to a concept absolutely essential to Chinese science, also represented in the Yin/Yang symbol: the concept of qi.
    Between the Two
    In addition to symbolizing the Law of Opposites by virtue of the black and white halves, the Yin/Yang symbol shows the two halves integrated as one, thus indicating not only the duality of yin and yang, but the trinity of yin, yang and their integration as one whole. In Taoist numerology, the Yin/Yang symbol is represented by the number three and is sometimes called a “Three in One.” The third, integrating factor, which harmonizes yin and yang and serves as a bridge between the two, is considered neutral; that is, neither yin nor yang. The concept of a mysterious middle ground between two opposites is very common in traditional Chinese culture. The original name for China itself was the “Middle Kingdom” or “Central Territory,” referring to the mystic realm “Between Heaven and Earth.” Hence, the third, integrating factor that bridges the material and spiritual realms is qi, the mysterious force of nature that is the unique cornerstone of Chinese science.
    The concept of qi has no equal in Western science because Western science, evolving as it did under a policy of non-involvement with matters of spirituality, is unequipped to address the subject, much less detect the reality, of a force that integrates the physical and spiritual realms.* On the other hand, the experiments carried out by the ancient Taoists to explore and confirm the spiritual realm were based on qi, with the understanding that the one carrying out the experiment was central to the process. This, again, contrasts with the Western scientific method, which dictates that the one carrying out the experiment remain an uninvolved observer. Like all else in creation, humans are a Three-in-One of physical matter, spirit, and qi. Qi bridges an individual’s physical and spiritual elements just as it does the physical and spiritual realms as a whole. This triad is expressed in Chinese Medicine by the term “jingqishen” with jing representing the physical essence and shen the spirit. By focusing on balancing one’s qi, one can develop the ability to align oneself with the qi of nature and experience the realm of spirit as surely as the physical realm.
    Think of it this way: the relationship between yin and yang is like the two sides of a seesaw. When one side goes up, the other goes down, and vice versa. Between the two sides is a balancing point, or fulcrum. If the balancing point is slanted to one side, the seesaw will be inclined to tilt to that side. If the balance point is perfectly balanced between the two, it encourages the two sides to find their true balance.
    The ancient Taoists believed humankind once had a good balance between our spiritual and physical sides, but over many thousands of years of evolution, we over-emphasized the physical. As the physical focus rose, the spiritual focus declined and the balance point, or qi, between yin (physical) and yang (spiritual) became slanted toward the physical side. Hence, people lost touch with their spiritual nature. The early Taoists developed methods to counter this tendency by balancing an individual’s qi. They encouraged students to practice these methods so they could confirm the existence of their spiritual nature for themselves rather than rely on religious faith or philosophical logic. By eating a carefully balanced diet, taking certain herbs, performing special exercises such as Tai Chi Chuan or qi-gong, and doing specialized meditative practices, an individual can restore the balance of body, mind and spirit.
    People who successfully practice these methods often undergo a profound shift in their perception of reality. Some will have mystical experiences, especially during meditations, in which they literally encounter the spiritual realm. I say this because I have practiced some of these methods and have had similar experiences myself. It was having this type of first-hand experience, rather than faith in an ultimate power or trust in the philosophy I studied, that convinced me the ancient Taoists were correct to assert there is another layer of reality available for us to study.
    Skeptics will say that none of what I’ve described qualifies as science because they are merely individual experiences, possibly even delusions. It is very hard for the Western mind, trained from childhood to trust only a certain type of “proof,” to accept such a foreign set of protocols as having any real worth. But what if the ancient Taoists were right? What if the scientific method of proof through experimentation could be applied to spirituality, but only through individual “inner” exploration? What if the Western scientific method, admittedly impotent in matters of spirituality, needs to undergo changes in order to study matters of the spirit?

  20. Ben Kavoussi says:

    Dear Matthew,

    The alleged distinction between Oriental and Occidental notions that you believe in, and so enthusiastically describe here, is called “Orientalism.” In a post that is scheduled to appear tomorrow, I will describe how “Oriental medicine” derives from a set of scholarly and popular fantasies about Eastern civilizations, Classical Eras, Golden Ages, scriptures, works of art, philosophies and religions where mysticism is set against the rationalism and detachment of the West.

    According to the late Edward Saïd (1935–2003) these notions are all Western fantasies which “exotice” the East while neglecting considerations of power.

    Mistaking your New Age fantasies about the Orient with historical reality is part of the “willful ignorance” I was referring to, since the history of medicine that you depict here, is simply a fairytale. The whole purpose of this site is to deconstruct and denounce confabulation, fantasy, ignorance and deceit, so they hopefully get abolished from the practice of medicine.

  21. pmoran says:

    Matthew, what “foreign set of protocols”? When you claim that you helped someone’s sciatica, or their migraine, or their blindness, what mysterious protocol are you applying?

    You are collecting information regarding the patient and using bog-standard non-spiritual logic (and assumptions) in order to arrive at certain deductions as to what happened. Clinical studies do PRECISELY the same but in a far less error-prone way.

  22. Harriet Hall says:

    If the “world of spirit” affects the world of matter, it will produce measurable effects that can be tested using the scientific method. If it produces no objectively testable effects, it might just as well not exist, and it remains in a nebulous realm of belief and superstition. There is only one science. The first hand proofs you describe are just another kind of testimonial, and they are unreliable. Your “mystical” experience is real, but your interpretation that it constitutes contact with another realm is not verifiable.

  23. Ben Kavoussi says:

    Indeed, Harriet, there is only one science. And in my post tomorrow, I will explain how the postmodern opposition to Enlightenment rationalism and the claim that science does not provide more access to the truth than any other fields of knowledge.

    As a result, a vast spectrum of ideas and practices sourced by Eastern religions, paganism, alternative science, astrology, and other beliefs emanating out of a general interest in the paranormal, have become popularized in last decades, and one of the results is the metaphysical nonsense we commonly hear from CAM practitioners, such as the “world of spirit” affects the world of matter!

  24. daedalus2u says:

    Mathew, are you saying that according to the Chinese “law of opposites”, there must be something that is the opposite of Science Based Medicine? Also something that is the opposite of the right way to practice medicine?

    SBM is self correcting through testing. How is Traditional Chinese Medicine corrected? How is research on acupuncture done to ensure that the acupuncture points being used are correct on a particular individual for a particular indication?

    My understanding is that there is no ongoing research to increase the understanding of how, why, where and for what conditions and by what mechanism acupuncture “works”. My understanding of what constitutes “research” in TCM is consulting references on the subject. There is no primary research being done to find out what works or doesn’t work, just consulting ancient texts to see if someone, somewhere, sometime wrote down that treatment xyz “worked” for indication abc.

  25. The Law of Opposites is a very profound and unique concept that asserts that there is nothing that can be described by the human mind that does not assure that an opposite of that thing must also exist. In other words, all descriptive concepts must have an opposite concept in order to distinguish that which you are describing. This is a very deep philosophical concept that would take a great deal of time to adequately describe. It would not apply to Science Based Medicine per se.

    As far as your criticism that there is no research questioning what works best, I agree. That is the one aspect of modern thinking that I believe Chinese medicine will greatly benefit from. We should test old concepts with new eyes. I am all for it. I am only against those trying to stop us continuing to use these time-tested techniques that are providing such safe and effective treatment for so many who are not being well managed by conventional therapy as we do this testing.

    Lastly, the term “mechanisms of acupuncture” I believe is a contradiction of terms. I do not believe acupuncture works in a mechanical manner and that is what has been wrong with recent research. The mechanical view of nature is a view of classical science that worked well for answering some questions but is now seen as being the wrong scientific model for exploring other features of nature. Take meteorology. Until the mid 1960’s it was believed that we would come to understand weather with the mechanical model until the “Butterfly Effect” was discovered – a phenomenon in which a tiny perturbation within a complex dynamic system could cause disproportionately large and unpredictable results. I have proposed elsewhere that acupuncture works via the Butterfly Effect as the human organism is a complex dynamic system as complicated as the weather on earth just as the Chinese said more than 2,000 years ago.

  26. Harriet Hall says:

    The Butterfly Effect can have far-reaching consequences but there is no way we can predict what they are going to be. If acupuncture depended on it, there would be no way of deciding how to treat.

  27. Hi Harriet,

    “The Butterfly Effect can have far-reaching consequences but there is no way we can predict what they are going to be. If acupuncture depended on it, there would be no way of deciding how to treat.”

    Well – yes and no. If acupuncture depends on the Butterfly Effect, there would be no ONE BEST way to treat as we look for in medicine operating under a mechanical view of nature. There should be only one best way to fix a machine with a specific identified problem. But in dynamic living systems in which Butterfly Effects can come into play, one needs to be open to finding multiple ways that may cause a desirable Butterfly Effect of encouraging stability and normalcy within that system. That is why there are so many different possibilities in acupuncture, so many possible point combinations and techniques that have shown themselves to be successful over these last 2,000 years. I always say the challenge in acupuncture is not coming-up with some treatment approach that has a legitimate chance of being effective, it is trying to sift through the very many treatment approaches that has some history of success and deciding which to use for plan A or then plan B, C, etc.

    If it is possible to manipulate the Butterfly Effect within living organisms to facilitate optimal self-regulation (as I assert acupuncture can do) then you would need to work at identifying multiple triggers that could accomplish this goal and this is exactly what we have with acupuncture. That is why so much of the acupuncture research is short-sighted in that the vast majority of these studies chose a set of points and continued to use these points regardless of if they were working or not during the trial. This is why these studies show a lower success rate of the so-called “real” acupuncture groups than is seen in real world clinical practice. One of the greatest skills of experienced acupuncturists is learning how to make multiple, ongoing, minor adjustments looking for the Butterfly Effect that finally clicks with the desired result. There have been very few placebo-controlled acupuncture studies (I know of only one) that even tried to take on-going adjustments into account and they did a poor job of it.

    I have used this analogy in a previous post but I respectfully ask that someone please address the issues I try to raise with this: Consider taking a group of people and lightly touching a spot (or spots) under their nose with a feather. Via the Butterfly Effect, it is possible such a light stimulus could trigger a disproportionately large reaction – a sneeze. Now a sneeze is a reaction our bodies have evolved for a positive self-regulation reason. In this analogy, one is using an outside, artificial stimulus (a light feather touch) to trigger a intrinsic, self-regulatory reaction. This is exactly what we do with acupuncture! The problem is, we don’t usually trigger a single, obvious, and immediate reaction such as a sneeze but rather a potentially wide-range of subtle self-regulatory reactions that usually (but not always) have a delayed effect and often a cumulative effect. Also – these reactions or not necessarily an all or nothing type like a sneeze but rather a modest boost of the self-regulatory reactions the body is already engaged in.

    Consider further the rate of reproducibility of the feather/sneeze experiment. If you find a spot that makes one person sneeze it may not do the same for another. Does that mean a sneeze thus triggered was the result of the placebo effect or is it that is was a real physiologically triggered reaction but identifying all the elements that must be aligned to reproduce this reaction is exceedingly difficult? Maybe this is due to subtle individual differences. But consider that even if you find a spot that makes one person sneeze one time, it won’t make even that same person sneeze every time because even the same individual is never the exact same individual at any two points in time.

    So, if you had a goal to make as many people sneeze as often as possible by lightly touching under their noses, you would not look for just one “best” spot but would look for several possible spots and try several to increase the success rates. After years of doing this on thousands of people, you might even come to believe there are very subtle clues to look for in you subjects that could lead you to suspect that for any given individual at a given point in time, one spot or another might work better than all the others. Over centuries of engaging in this practice, complex theories reflecting the prevailing worldviews of that age may be postulated to explain how triggering sneezes with feathers works.

    This is essentially what we do with acupuncture. The level of Butterfly Effect is somewhat akin to triggering a sneeze with a feather – some relatively more reproducible like endorphins or helping nausea, others relatively less reproducible like to acupuncturists who posted about correcting stroke complications with one treatment. And yes – sometimes the effects are placebo but other times it is the Butterfly Effect. Over more than 2,000 years of clinical experience, we have learned many different techniques that help improve our odds of triggering beneficial reactions although these improved odds can be difficult to demonstrate in controlled trials or separate from placebo.

    Would anyone care to comment on my feather/sneeze analogy? After all my years of deep interest in this subject, I believe this analogy to be the most constructive exercise for constructive discussion.

  28. pmoran says:

    Matthew, you asked for comments.

    1. Placebo responses is the simplest and most complete explanation for it all, including why more experienced practitioners might seem to get better results than are usual within controlled trials.

    Those able to keep the patient interested in treatment while they try their “many different techniques” will also have tincture of time on their side as an aid to the resolution of, or the coping with, many common conditions.

    2. You say: “After years of doing this on thousands of people, you might even come to believe there are very subtle clues to look for in you subjects that could lead you to suspect that for any given individual at a given point in time, one spot or another might work better than all the others.”

    I don’t buy this. The individual human mind has very limited ability to reliably retain and interpret such large anounts of data, tending to be dominated by most recent experience and being inclined to see patterns where none exist.

    Placebo responses will, however, be favored by the apparently superior wisdom, confidence, and arcane arts of the more experienced practitioner

    3. Individuality of patient responses creates its own problems. The more individual they are, the less likely it is that the practitioner is going to hit upon the best treatment within the period dictated by patient tolerance. Soon there is so little likelihood that past experience can predict what might be useful for the next patient, that the science of medicine ceases to exist.

    4. Remember that homeopathy, traditional chiropractic, naturopathy, and various other dubious “alternative” discplines all make very similar claims to acupuncturists despite vastly different theoretical approaches. Occam’s razor allows, no, compels us to postulate that placebo responses and various allied illusions of normal medical practice can allow such modalities to “serve as medicine” for many people.

  29. Dr. Moran,

    What I hoped I could get feedback on is the general postulate that it is possible to trigger a sneeze from lightly touching under the nose with a feather but that this reaction might prove quite difficult to reproduce. It would prove difficult to understand the mechanisms behind why a sneeze might be triggered when a specific spot is touched but not happen when the same spot is touched in the same way. My postulate is that such a reaction is an example of a Butterfly Effect in which a small protuberance may cause a disproportionately large response. Of course, my next postulate is that this is how acupuncture works but I am not seeking feedback on that second claim just the first part.

    And by the way – I make no claims for anything other than acupuncture and Chinese medicine as that is what I have experience in. It does a disservice (although perhaps is convenient) to lump them all together.

  30. daedalus2u says:

    Mathew, what you call the “butterfly effect” is better known as mathematical chaos. A very great many systems of multiple coupled non-linear parameters exhibit chaos when the number of parameters is greater than a few. Virtually all physiological processes are chaotic when they are working properly.

    The human brain is chaotic and operates at the critical percolation threshold, a true critical point, where it takes a differential stimulus to cause a macroscopic change of state.

    Manipulating someone’s psychology is utilizing what you call the butterfly effect. That is what the most skilled practitioners do. They get to be really good at it, so good that they fool themselves and their clients into believing that they are doing something other than manipulating the psychology of the client. People are suggestible. When you are good at reading people, then you can manipulate them into thinking you are doing something that you are not. That is what cold readers do all the time.

  31. pmoran says:

    “A very great many systems of multiple coupled non-linear parameters exhibit chaos when the number of parameters is greater than a few. Virtually all physiological processes are chaotic when they are working properly. ”

    Is this the problem with Mathew’s analogy? The feather is not a parameter for the effect observed in the way the flap of the butterfly wing is.

    It is also not clear that acupuncture needles have the capacity induce chaos in any physiological, biochemical or immunological system. I mean acupuncture points are subject to accidental stimulation all the time. As a surgeon I have been devastating to some and excised others without ever seeing obvious systemic effects.

    Mathew, you would have to find some animal, human or pathological model for the effects you claim before they could be taken seriously. Remember almost anything can release endorphins.

  32. daedalus2u says:

    In a chaotic system, essentially any stimulus can have essentially any effect provided the right stimulus happens in the right place at the right time. In the butterfly’s wing analogy, the flap of the wing has to be at exactly the right place in exactly the right time. A foot to one side, or a few seconds earlier or later and a completely different outcome will happen.

    To manipulate the weather using flaps of butterflies requires knowing the “details” of the system being influenced to a substantially better degree of precision and on the same energy, time, and space scales as the flaps of butterflies’ wings, and over the entire volume of interest (tens of thousands of square miles or more). That means knowing the details of every butterfly, every bird, everything adding energy to the atmosphere, every obstacle, every cloud, every leaf, how each leaf bends and changes the air flow in response to a puff of air, how much water transpires through each leaf, every detail, and then computing the contingent outcome based on different flaps and choosing the right flaps to achieve the outcome you want. Not impossible, but a very high degree of difficulty.

    For Mathew to be saying that he uses the “butterfly effect” for his acupuncture needling to influence physiology, means that he has to know and be able to compute the influence of his needling on the outcome. He has to be able to “read” the physiological state of the individual, observe how his needling is changing that, and then modify his needling so as to achieve a final physiological state through needling. If he were actually able to do that, then he would be able to read physiology to such a degree that he could not be tricked. He would have to precisely know the potential physiological state outcomes and select the one he wants to achieve and then chaotically manipulate the individual’s physiological state until the desired one is achieved.

    Of course he doesn’t know and can’t know an individual’s physiology to that degree. The qi he thinks he is manipulating doesn’t exist and doesn’t flow in channels where he thinks it does. He is simply deluding himself into thinking that it does and that he can manipulate it. What he is doing is influencing the psychology of his client. The client’s psychology is much simpler than his/her physiology and the client’s psychology does couple to the client’s physiology through the CNS to the ANS. The ANS does have a great deal of information about the physiological state of the individual. Mathew can’t tap into that information, but the CNS of the individual can, and by manipulating the individual’s CNS through psychology, Mathew can (very indirectly) manipulate the ANS. This is how Mathew is using the “butterfly effect”. It is the same way that all placebos work, via manipulating the psychology of the individual.

  33. I really appreciate these comments. I find them constructive and if there is the interest and time allows, I would offer comments of specifics but what I would rather do is shift this line of discussion back to the main theme I was trying to bring-up and that is the general prospect of the ability to craft a medical intervention whose sole focus is attempting to stimulate intrinsic resources. Do any of you out there believe that it MAY be possible to stimulate – facilitate –enhance – an organism’s intrinsic resources for the purposes of improving health? Please respond.

  34. daedalus2u says:

    Matthew, yes, that is exactly what placebos do, when they are effective. I discuss the physiology of placebos on my blog. I see the placebo effect as part of the normal allocation of resources. When one is under stress, and the “fight or flight” physiological state is triggered, resources are allocated away from healing and diverted and held ready to be used for immediate consumption as when running from a bear.

    http://daedalus2u.blogspot.com/2007/04/placebo-and-nocebo-effects.html

    All placebos work the same way, they trigger the end of the “fight or flight” state and invoke the physiological state where healing is turned back on.

    Essentially all degenerative diseases are a consequence of the “fight or flight” state being on for too long. The “fight or flight” state is not simple, there isn’t a single “fight or flight” state, there are likely thousands or tens of thousands or more, the “details” depend on the “details” of what stress the body is trying to respond to and the idiosyncratic physiology of that individual.

    A major class of “fight or flight” states are the states invoked by ischemic preconditioning. These are triggered by low NO, and can be observed in the brain as spreading depression, also known as migraine. People who experience migraines do show lesions characteristic of hypoperfusion and ischemia in the brain. The brain is unique in that it can’t run on glycolysis, so ischemic preconditioning occurs more readily and to a larger extent than in most other tissue compartments. Ischemic preconditioning is a beneficial, even life-saving feature of metabolism. But it can only be a transient state and if it goes on for too long there are adverse consequences. My hypothesis is that long term neurodegeneration is the adverse consequence of ischemic preconditioning gone on for too long.

  35. So are you saying that you do not believe it is possible to stimulate intrinsic resources by any physical/physiologic manner other than placebo?

  36. daedalus2u says:

    No, you can trigger the ending of the fight or flight state and the invocation of the healing state by reducing the threshold for triggering the placebo effect. There is quite good evidence that the placebo effect is triggered by neurogenic release of NO, so by increasing the basal NO level you decrease the threshold for triggering the placebo effect. If you reduce the threshold enough, you have triggered it. That is what I think I can do by increasing the basal NO level.

    Beyond that, I don’t think there is any other way. The regulation of resource utilization is extremely complex and has evolved in humans (and all other organisms) over evolutionary time. That control system is so complex that it is difficult to “hack into” (which is essentially what all of medicine and healing therapies are trying to do) without adverse side effects. Healing requires the concerted and cooperative activity of many thousands of pathways working “in sync”. The only methods that are going to work are going to be ones that are compatible with and invoke the normal evolved pathways and so tie into those thousands of pathways more or less seamlessly.

    Something as non-physiologic as acupuncture has no evolved component. The a priori likelihood of something like acupuncture tapping into physiology is microscopic, and that there is now no hint of any relevant physiology other than the placebo effect is (to me) very strong evidence that acupuncture is simply a placebo.

  37. So if one can induce a sneeze by touching under the nose with a feather, that is a placebo fright or flight sneeze?

  38. “The regulation of resource utilization is extremely complex and has evolved in humans (and all other organisms) over evolutionary time. That control system is so complex that it is difficult to “hack into” (which is essentially what all of medicine and healing therapies are trying to do) without adverse side effects. Healing requires the concerted and cooperative activity of many thousands of pathways working “in sync”. The only methods that are going to work are going to be ones that are compatible with and invoke the normal evolved pathways and so tie into those thousands of pathways more or less seamlessly. ”

    “Something as non-physiologic as acupuncture has no evolved component.”

    I agree with your first statement quoted above but not the second and let me explain why.

    I agree that resource utilization is extremely complex and evolved in living organisms over very long periods of evolutionary time. In the fleshed bipeds, one of these evolved resource utilization mechanisms was touch. Although no one has studied this seriously, touching sore spots facilitates resource utilization, in other words, rubbing a boo-boo really does make it better. In my book, I postulated a detailed theory explaining that acupuncture evolved from acupressure that evolved from massage that evolved from the (likely) instinctual practice of rubbing sore spots. Acupuncture is a form of touch therapy that takes advantage of the resource utilization that can be caused by touch.

    In my book, I postulate a theory that details the evolution of several milestones that lead ancient people from the practice of rubbing sore spots to the eventual use of needles. I believe this is the way acupuncture came into existence not only because this is mentioned in some oral folk legends but mainly because of my own experience working with both acupressure and acupuncture.

    I used to work as an auto body mechanic fixing dents in cars. I know like to say that I now work as a human body mechanic because I found similarities in both lines of work. Auto body mechanics need to develop a fine sense of touch so when they rub their hands over a body panel, they can feel every little ding or scratch or even the difference in a few layers of paint.

    In acupressure/massage work one needs an even finer sense of feel as one searches for very tiny inconsistencies in the texture of the flesh. Many (not all) acupoints are spots that have a higher than usual tendency to develop inconsistencies in their normal tone and one can often work these out by applying just the right type of touch. In some of these spots however, one can sense that the epicenter of the inconsistency is buried within the muscle and difficult to reach by hand and that is where the idea of reaching these spots with some sort of extension of the fingers came into play.

    Unless someone has spent years refining their sense of touch in the manner described above this may seem like a far fetched theory. I like to say this is like learning to play a delicate stringed instrument. The uninitiated may think one could never make their fingers work like that but with years of practice it is possible. Have you ever had a good massage where the massage therapists found tender spots on you that you never knew where there? Those were acupoints. The ancient Chinese developed their knowledge of these spots to remarkably sophisticated levels eventually leading to acupuncture..

  39. daedalus2u says:

    What possible evolutionary pressure is there to evolve control points on the external surface of an organism that can only be activated by others?

    If we postulate that such points exist, how did they evolve? As a direct line to the organ system being affected (which there is no evidence for because nerves don’t go from those points to the supposedly affected tissue compartments)? Or using the CNS as an intermediary? If the CNS is the intermediary, is the signal sent via touch and sensory nerves or via the observations of the client that someone is ministering to them and trying to help them get better?

    Humans are social animals, and touch is a communication method that humans use. I would distinguish a “physiological” effect of touch, as in enhanced movement of lymph from a “communication” effect of touch, mediated through emotional and psychological effects.

    If the stimulation of a certain spot on the skin had effects on physiology, it would be easier to evolve a direct neurogenic control of those spots than for evolution to wait until the organism had evolved sufficient cognition to learn that certain spots were effective, learn how to consciously stimulate them to produce healing effects, and then to acquire metal working in order to learn that needles worked better still. That learning has now culminated with the discovery that toothpicks work as well as needles, so the metal working step was not necessary. So why did they use needles if toothpick work just as well? When needles were first used, they were expensive bits of metal and toothpicks were not. An expensive placebo works better than a cheap placebo. Now all the cost is in the labor, not the needles or toothpicks, so they both work the same.

    I don’t disagree that rubbing something can make it feel better. That is the placebo effect. If it takes years of work to develop such a fine sense of touch that one can use that touch to heal another, how can the ability to be healed by such a touch evolve before there was such a refined sense of touch to invoke it? We know there is such a thing as the placebo effect. It is much easier for an organism with a physiology that can support a placebo effect to learn to invoke that placebo effect via a new mechanism that to evolve de novo a new physiological control system (for which there is no evidence).

  40. Folk history teaches that the first needles were slivers of bamboo and select fish bones. In actual practice we use many different tools to try to normalize the inconsistencies in the flesh I referred to including instruments that don’t penetrate the surface. This is similar to auto body work where we work with different tools to smooth-out imperfections in metal.

    There has been a grand total of one study that showed tooth picks worked as well as needles and both of them worked twice as well as conventional therapy. If you are ready to declare the first and only toothpick trail as the final word on the subject, I guess I can’t convince you otherwise.

  41. khan says:

    So how much is The Tooth Fairy leaving today?

  42. daedalus2u says:

    Matthew, living human flesh is not “similar” to metal work.

    When the first (and only) trial using toothpicks in an attempt to simulate acupuncture produces results indistinguishable from acupuncture with needles, it is a fair assumption that acupuncture with toothpick activates the same physiological pathways as acupuncture and that they share the same basic and fundamental physiology. When similar research shows that the location of stimulation points is not important, and that piercing the skin is not important, then placebo acupuncture and real acupuncture are indistinguishable. To me that says they are the same; they are both placebos.

    If pressure points evolved so that organisms could regulate their physiology, then only humans could have them. The ability to use tools to apply pressure to specific points is only a human trait. No other organism can use tools to apply pressure to specific points, no other organism could derive an evolutionary benefit from the application of pressure to specific points to regulate physiology, no other organism could evolve a physiology regulated by pressure points.

    The utilization of pressure and acupuncture points is not instinctive, it is learned. Presumably if a physiological system evolved to control something as important as allocation of metabolic resources, humans would have evolved an instinct to know that, and to instinctively learn how to use it, the way we learn how to hear, move, speak and see. Because there is no instinctive compulsion to learn acupuncture, I think it is very unlikely that the ability to have one’s physiology regulated by acupuncture evolved as a trait separate from a generic placebo effect.

    Presumably something as fundamental as regulation of the allocation of resources should derive from deep evolutionary time and should be conserved from deep evolutionary time. Every organism other than humans regulates their physiology just fine without utilizing pressure points and without having the tools to activate them.

    Humans share ~99% of their DNA with chimpanzees. There is no hint that there is a completely separate and additional physiological system for regulating human physiology in addition to the systems for regulating chimpanzee physiology. No extra set of nerves, no different nerve types set up along the meridians to transduce the signal of pressure or needling into physiological regulation.

    The health of chimpanzees is made worse by stress, presumably they have the same type of allocation of metabolic resources that humans have which cause human health to decline under conditions of stress. Presumably stress reduction will improve chimpanzee health the same way it improves human health and by the same mechanisms. I suggest that common mechanism is what we call the placebo effect.

    The placebo effect derives from deep evolutionary time. All organisms exhibit the allocation of resources over time. All organisms exhibit adverse health effects from exposure to stress. All stressed organisms exhibit improved health when that stress is relieved. That is the essence of the placebo effect. Essentially all organisms have the capacity to exhibit a placebo effect. We should be surprised if an organism doesn’t exhibit it.

    There are many different types of CAM. Essentially all of them have no plausible physiological explanation other than that they invoke the placebo effect. The placebo effect explains acupuncture, reiki, homeopathy, crystal therapy, magnet therapy, herbal therapy, chiropractic, colloidal silver, massage, liver flushes, coffee enemas, toxin flushes, and essentially every other type of CAM.

    We should not be surprised when any particular human exhibits a placebo effect from a treatment they have been told will work. We expect people to exhibit placebo effects. That is why anecdotes have such limited evidentiary power.

  43. pmoran says:

    “There has been a grand total of one study that showed tooth picks worked as well as needles and both of them worked twice as well as conventional therapy. If you are ready to declare the first and only toothpick trail as the final word on the subject, I guess I can’t convince you otherwise.”

    Actually many different types of sham have been shown to work about as well as true acupuncture.

    And, allowing for the difficulties in completely blinding such studies so as to exclude patient cueing, the negative results do have more force than some mildly positive ones.

    The notion that the results of acupuncture are mainly a combination of placebo, spontaneous changes and biased patient reporting is not something we choose to believe, it is the point at which a wide variety of evidence is converging.

  44. daedalus2u says:

    Matthew, there may be only one study that shows that acupuncture with needles is the same as acupuncture with toothpicks. There are no studies that show that they are different. Your hypothesis that they are different has no supporting data.

  45. sstumpf says:

    This is a fascinating dialogue. I have learned much about placebo effect, chaos theory, Matt Bauer’s ideas about how acupuncture works, and his views on Western scientific history which seem to terminate with Galileo and the Roman Catholic Church. I do not think I have learned much about taosim although I find it remarkable that a thread that Ben begins with the fallacy of grounding acupuncture in religion finds a productive and sincere supporter doing just that; grounding acupuncture in religion. I have read about the Chinese Law of Opposites and Systematic Correspondence while practicing a fundamental principle of educational philosophy: try to understand what the other person is talking about before venturing into the fray. By the way, Scheid covers Systematic Correspondence pretty well.

    In my last post I strongly recommended that Matt read Bausell’s book on placebo effect and CAM research. I am posting very few excerpts from this highly useful investigation (Snake Oil Science, Bausell, 2007) that hopefully will finally clarify for Matt what is the placebo effect.

    Placebo is translated from Latin “to please”. An early 19th century definition was “given more to please than to benefit the patient”. Seminal research was published in JAMA in 1955 by Beecher who showed 35% of patients that received a placebo across 15 clinical trials responded positively. Beecher reasonably suggested that if any “non-harmful” therapy used in a clinical trial has the potential to produce this proportion of positive results then how can any trial be conducted without a placebo control group?

    Bausell defines the placebo effect as “any genuine psychological or physiological response to an inert or irrelevant substance or procedure”. Critical to the placebo effect is that the patient and the provider believe they are administering and receiving an effective treatment. Acupuncture certainly meets those criteria which I would guess occurs far more frequently than in mainstream medicine. However, I really do not know this and this is my own opinion founded on my own belief.

    Bausell goes on to suggest that placebo and many CAM therapies are the same thing. He writes about “natural impediments to making valid inferences” which is a chapter worth reading. He begins with the fallacy of making causal inferences based on associated findings (Research 101).

    What does Bausell know about acupuncture research? Plenty. Bausell was the Dir of Research at the NIH funded Complementary Medicine Program, the most successfully funded center under NCCAM. He describes most acupuncture research is poorly conducted. He aserts the placebo effect is a good effect. It works. The question is, as Bausell states it, whether acupuncture is anything other than a fanciful placebo.

    All the references to taoism and complex theories outside medicine, anatomy or physiology is mental three card monty. Ben’s Gold Tooth article is about how far folks will go to delude themselves and others. The acupuncture profession that abides by TCM and supposed “ancient Chinese wisdom” is anti-intellectual (IMO) and, contrary to another widely believed myth, 50% of licensees are either not working or not earning a living. Matt may have thousands of patients that he cares for between lengthy posts. However, the workforce facts suggest he is the exception and not the rule. The few published studies tell a story of a “healthcare profession” where 70% of licensees earn less than $60,000. Acupuncture is not listed with the Bureau of Labor and Statistics because the profession is unable or unwilling to provide fundamental information about the workforce. Coincidence? Not the way I see it. That is my opinion.

  46. Ben Kavoussi says:

    Dear sstumpf,

    Very well, said, thank you, you make some excellent points.

    Please copy-paste some of your remarks on the placebo effect under Peter Lipson’s post, Placebo is not what you think it is. As for the illusory nature of the profession, I will write a post soon.

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