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Oriental Medicine or Medical Orientalism?

The following is the second adapted excerpt of an upcoming article called “The Untold Story of Acupuncture.” It is scheduled to be published in December 2009 in Focus in Alternative and Complementary Therapies (FACT), a review journal that presents the evidence on alternative medicine in an analytical and impartial manner. This section argues that the current flurry of interest in acupuncture and Oriental Medicine stems predominantly out of postmodern opposition to Enlightenment rationalism, and bears witness to Orientalism and consumerism in contemporary medicine.

In five years, from 1971 to 1975, l directly experienced Est [Erhard Seminars Training], gestalt therapy, bioenergetics, rolfing, massage, jogging, health foods, tai chi, Esalen, hypnotism, modern dance, meditation, Silva Mind Control, Arica, acupuncture, sex therapy, Reichian therapy and More House — a smorgasbord course in New Consciousness.1

 Jerry Rubin (1938 – 1994)

Although acupuncture has been known in the US since the 19th Century, its therapeutic claims were dismissed or judged to be “much overrated” by the medical community.2,3 Nonetheless, the publication of a report in the New York Times by James Reston, a reporter in President Nixon’s press corps who had received acupuncture for postoperative cramps in Beijing in 1971 changed this perception, and triggered a flurry of interest amongst the American public and some in the medical community.4 Within the following months, journalists, scientists and physicians rushed to China to withness this peculiar phenomenon, which the popular press and a few scientific journals sensationalized by reporting that thousands of successful operations of all sorts were being carried out in PRC using acupuncture anesthesia; some elaborated on its widespread use for a myriad of conditions, to include paralysis and deafness!5

These unconfirmed claims in the heady social and intellectual climate of the 1970s–meaning the American Counterculture; the rejection of mainstream values, beliefs and ideals; the youth movement, nonconformism and the hippie subculture, the belief in a “New” and  “Cosmic” consciousness and the cult phenomenon; revolutionary ideas mixed with environmentalism; organic farming and the avoidance of pollution, agrochemicals and pharmaceuticals; nonconformism and alternative lifestyles; a syncretistic mix of psychedelic drugs, Eastern religions and Native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;6,7 and the belief in the existence of a separate and non-ordinary reality, as upheld by one of the fathers of the New Age movement, Carlos Castaneda8–gave the justification to view acupuncture as a “heal all” therapy based on alternate perceptions of health and disease.  This amalgamation happened precisely when a whole generation of disenchanted Westerners were eager to find novel solutions for their existential predicaments; one that would be free from the constraints of the so-called “repressive rationality” of modern science in “overdeveloped” societies.9,10. Most Western publications on acupuncture therefore fostered the belief that Eastern healing arts have crucial characteristics directly and unequivocally opposite to the repressive rationalism of the West.

This unfounded belief seems to stem out of our collective amnesia about lancing and bloodletting, and the belief in the existence of pneuma, or other vitalist notions that have been part of European natural philosophy and medicine since the Greek Antiquity. Indeed, as a result of successive epistemological ruptures11 during the last five centuries, medicine in the West has gradually evolved from late medieval astromedicine and humoral pathology to the molecular medicine and cellular pathology of today. Therefore, fundamental notions that once underlined European medicine have gradually become so foreign to us that their Eastern counterparts now seem to be based on worldviews fundamentally different than ours. But in the eyes of many historians and epistemologists, they have always appeared as similar to ideas that prevailed in Pre-Enlightenment Europe, and based on which the Fasciculus Medicinae12 and other late medieval medical treatises were written.

These ideas continue to find an audience in todays’s post-Counterculture era due to the continued postmodern opposition to Enlightenment rationalism and the claim that modern science does not provide more access to the truth than any other fields of knowledge–that scientific discourse is mainly just another coherent “narrative” or “language-game” governed by a set of protocols and a special terminology.13,14 In this climate of incredulity toward “metanarratives” and universal knowledge, many nonscientific forms of knowledge have gained legitimacy and popularity as a result of the prevalence of postmodern culture, politics and economics. Many ancient, folkloric and traditional systems of medicine have thus appeared as compelling narratives, perceived by patients as legitimate and equivalent but opposite to the logical empiricism of modern science.

The persistence of such ideas is also due to what the late Edward Saïd (1935–2003) has called Orientalism. In a 1978 publication by the same name, Saïd convincingly argued that the idea that Eastern cultures have crucial characteristics directly and unequivocally opposite to the West is a Western construct that “exotices” the East while neglecting considerations of power. Saïd argued that the alleged distinction between Oriental and Occidental thought primarily 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.15 Saïd also argued that this mythical Orient is a mere fiction that serves to represent the hidden desires of Western cultures, a mysterious “Other” onto which we project our fantasies.16 The pervasiveness of such projected fantasies about Eastern reactions to health and disease onto acupuncture and Chinese medicine, certainly confirms Saïd’s argument. The fictional character of this “Other” medicine can be further perceived in the indecisiveness of the professional associations and the regulatory agencies to refer to acupuncture and related modalities as “Chinese,” “Oriental,” “Asian” or “Eastern,” for these utterly broad “umbrella” categorizations are based on political correctness, and do not correspond to any geopolitical and historical reality other than a geographical and philosophical “orient”-ation.

Paradoxically, while the theme of “evidence of effectiveness” was gradually becoming a central part of international, national, and regional public health dialogue in the 1980s and 1990s,17 medical Orientalism became an important commercial phenomenon by becoming synonymous with the fashionable and eclectic New Age notions of “natural,” “alternative,” “holistic” or “integrative,” and has since catered to health-consumers who aspire towards traditionalism and spirituality,18 and who believe in a vast spectrum of ideas and practices sourced by Eastern religions, paganism, alternative science, astrology, and a range of other beliefs emanating out of a general interest in the paranormal.19,20 In a fascinating article on cults in American, Camille Paglia explains how the New Age movement gradually became an international commercial success in the 1990 with specialty shops and mail-order catalogs supplying the “ritual paraphernalia of amulets and talismans, healing crystals, angel icons, incense, candles, aromatherapy bath salts, massage rollers, table fountains, wind chimes, and recordings of trance music in Asian or Celtic moods.”21 To this, she could have added herbal products, various types of yoga, chakra and energy healing, tai chi, qi gong, reflexology, reiki, shiatsu and also acupuncture, where, as Robert Frank and Gunnar Stollberg have argued, “physicians tailor their practice to the individual patient’s (perceived) demands.”22 This international commercial success has undeniably benefited China’s export of medicinal herbs and acupuncture related products, especially when their domestic use is in sharp decline due to the broader availability of modern medicine in a country that strives to reach the top in science and technology. 

At last, considering how the popular press in the 1970s created an enormous interest for acupuncture in the West; how many books by authors who often did not have any familiarity with Chinese history, culture and language popularized a set of unexamined assumptions about the mythical Oriental and its medicine; and how they persists merely due to a set of social, intellectual and economical factors; it is pertinent to evoke Bernard le Bovier de Fontenelle’s (1657–1757) words of wisdom, who in 1687 in Histoire des oracles wrote what should be the “mantra” of all serious endeavor and publication in alternative medicine: “if the truth of a fact were always ascertained before its cause inquired into, or its nature disputed, much ridicule might be avoided by the learned.”23

REFERENCES:

  1. Cross G. An All-Consuming Century: Why Commercialism Won in Modern America. Columbia University Press. 2000.
  2. Cassedy J. Early uses of acupuncture in the United States, with an addendum (1826) by Bache F, MD. Bull N Y Acad Med 1974; 50: 892–906.
  3. Gross S. A System of Surgery. Philadelphia: Blanchard & Lea, 1: 1859.
  4. Reston J. Now, about my operation in Peking; Now, let me tell you about my appendectomy in Peking. New York Times. July 26, 1971:1.
  5. Reisser PC, Reisser TK, Weldon J. New Age Medicine: A Christian Perspective on Holistic Health. Intervarsity Press. 1988.
  6. Turner F. From Counterculture to Cyberculture: Stewart Brand, the Whole Earth Network, and the Rise of Digital Utopianism, University of Chicago Press. 2006.
  7. Roszak T. The Making of a Counter Culture: Reflections on the Technocratic Society and Its Youthful Opposition. University of California Press; New Ed edition. 1995.
  8. Castaneda C. The Teachings of Don Juan: A Yaqui Way of Knowledge. University of California Pres. 1968.
  9. Unschuld PU The reception of Oriental medicine in the West. Lecture given in Kobe, Japan, May 1995. www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/u1/reorme.pdf. Accessed March 2009.
  10. Marcuse H. One-Dimensional Man: Studies in the Ideology of Advanced Industrial Society. Beacon Press. Boston. 1964.
  11. Bachelard G. Formation of the Scientific Mind. Clinamen Press, Manchester. 2002.
  12. Ketham, J de. The Fasciculus Medicinae of Johannes de Ketham, Alemanus : facsimile of the first edition of 1491. With English translation by Luke Demaitre ; commentary by Karl Sudhoff ; trans. and adapted by Charles Singer. Birmingham: Classics of Medicine Library, 1988.
  13. Lyotard JF, Thébaud JL, Godzich W (translator). Just Gaming. University of Minnesota Press, Minneapolis, 1985.
  14. Powell J. Postmodernism For Beginners. New York: Writers and Readers. 1998.
  15. Powell J. Easter Philosophy For Beginners. New York: Writers and Readers. 2000.
  16. Sim S. Introducing Critical Theory. Totem Books. 2002.
  17. Anderson LM, Brownson RC, Fullilove MT, Teutsch SM, Novick LF, Fielding J, Land GH. Evidence-based public health policy and practice: promises and limits. Am J Prev Med. 2005 Jun;28(5 Suppl):226-30.
  18. Sedgwick M. Against the Modern World: Traditionalism and the Secret Intellectual History of the Twentieth Century. Oxford University Press, 2004.
  19. Siapush M. Post-modern values, dissatisfaction with conventional medicine and popularity of alternative therapies. J Sociol 1998; 34: 58-70.
  20. Partridge CH. The Re-enchantment Of The West: Alternative Spiritualities, Sacralization, Popular Culture, and Occulture. T. & T. Clark Publishers. 2005.
  21. Paglia C. Cults and Cosmic Consciousness: Religious Vision in the American 1960s, Arion, Winter 2003.
  22. Frank R, Stollberg G. Medical acupuncture in Germany: patterns of consumerism among physicians and patients. Sociol Health Illn. 2004 Apr;26(3):351-72.
  23. Fontenelle BLB (Author), Bergier J (Editor). Fontenelle: Entretiens sur la Pluralité des Mondes suivi de Histoire des Oracles. Marabout Université. 1973. 

Posted in: Acupuncture, History, Science and Medicine

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53 thoughts on “Oriental Medicine or Medical Orientalism?

  1. Ed Whitney says:

    Do you happen to have any information about this journal? It is not in my library and appears not to be indexed in Medline. It sounds interesting but I wonder why PubMed does not have any entries for it.

  2. Laurel says:

    Very nice post. I’ll be directing people to this one…and rereading Said.

    For a history of white Americans’ exoticism of Native American religions, I like Dream Catchers: How Mainstream American Discovered Native Spirituality by Philip Jenkins.

  3. Laurel says:

    (sigh) that’s How Mainstream America Discovered, et cetera.

  4. Ben Kavoussi says:

    Hi Ed,

    I assume you are asking about FACT. It is indeed not PubMed indexed. Here’s the website:

    http://www.pharmpress.com/shop/journals.asp?a=1&cid=27

    The Editor-in-Chief of FACT is Edzard Ernst, Laing Chair in Complementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, UK

  5. Ben Kavoussi says:

    Thank you, Laurel, for the reference on Native Americans.

  6. Scott says:

    I am reminded of some people I know who are completely convinced that the quality/correctness/value of anything is entirely determined by whether or not it’s Japanese.

    We should have a law that you can’t wear shoes indoors, because that’s what the Japanese do, and there must be a good reason for it. English should be converted to use kanji because those are so much better than our letters. Five samurai could kill an entire company of Marines, because they would be able to ignore being shot full of bullets. And so on.

    I wish I were exaggerating, but I’m not. It basically seems to me to be the extreme form of what Ben’s describing.

  7. woo-fu says:

    Humans do tend to go polar over the “other”, demonizing, idolizing or managing to do both, paradoxically, at the same time. This is another good example of the problem. And while the intermingling of the social and political forces seems to have culminated in the present state of New Age idealism, other issues are at stake as well.

    I think you might be ignoring individuals who use alternative techniques to achieve psychological effects, such as improving focus and concentration, reducing stress or even as a creative vehicle to discharge emotions and establish a sense of balance. A good drum circle can create a very positive experience for the participants, meditation might help individuals cope with pain, biofeedback works for others. These techniques are not panaceas and shouldn’t be marketed as such; however, by dismissing them as valueless you might also be devaluing other aspects of human experience.

    No belief in the supernatural or separate realities other than internal versus external experience is required to understand the point. Shared external experience builds our perceptual reality, which can be tested and experienced by others. However, internal experience can certainly have very real, physical and psychological effects on the one having the experience, one which is not easily shared or explained to others, the basis for “the mysteries”.

    This internal, personal experience is more easily moved, at least in some individuals, by techniques such as those listed above rather than by reason alone. That this internal shift might effect an external change for an individual shouldn’t surprise anyone. The problem is in asserting that these techniques work for everyone for every problem. Individuals coping with their problems creatively shouldn’t be at odds with simultaneously benefiting from science-based medicine. However, creative techniques should be viewed as such, so charging outrageous prices to experience or learn them is absurd.

    The mention of yoga and tai-chi also prompts me to add that while not panaceas, these practices can work well as exercise, particularly when modified to individual patient needs by a competent physiotherapist. This does not mean that everyone needs to sign up for a class or rush for equipment, it may well be that the stretching and gentle movement these techniques employ simply make for a good component of well-rounded cross-training. Of course, like everything else, they won’t be right for some, so a physician’s advice would be, well, advisable.

    I get where you’re coming from, Dr. Kavoussi; at least, I believe I do. It grossly oversimplifies the matter to view alternative techniques as ancient treasures preserved intact with special secrets which cure all ills. You are right to remind us that many are rooted in ancient beliefs later discarded by the very cultures which held them sacred.

    However, it also oversimplifies the matter to say there is absolutely no role or value in at least some of the techniques listed. What is called for is to find the pearls of wisdom hidden by so much flotsam and jetsam.

  8. glasstree says:

    This clearly describes the mid-term origins of acupuncture’s popularity.

    typo in the last sentence of the 2nd paragraph:
    withness

    This sentence quoted below makes me uncomfortable. It might be the specific claims without citation, might be some grammatical awkwardness, or it might just be me and not worth worrying about.

    This international commercial success has undeniably benefited China’s export of medicinal herbs and acupuncture related products, especially when their domestic use is in sharp decline due to the broader availability of modern medicine in a country that strives to reach the top in science and technology.

    It seems like the word Oriental has itself acquired a connotation as a word used by people who make uninformed statements about various ethnic groups and cultures. I have also not heard anyone younger than 50 use that word here in California.

  9. Where to begin? First you quote Jerry Rubin (!?) to make acupuncture (but not jogging) sound flaky by association. Then you invoke Carlos Castaneda who has nothing to do with Oriental medicine as somehow providing a separate and non-ordinary reality that the medicine doesn’t need. Throw in a little cosmic consciousness, trash organic food, add a touch of Edward Said’s Orientalism and you have turned it into the perfect straw man.

    But what is the point? Acupuncture works. You can make areas of the brain that affect migraines light up on a MRI by using the associated acupuncture points on the toe, or areas that affect the lower back light up by needling the back of the knee. Radioactive isotopes injected into acupoints follow meridians, which are spaces rather than structures. People who would have responded to the placebo effect of western medicine, if that is all it were, respond to acupuncture after other treatment fails.

    I had a client who suffered from a bad stroke and came after a year and a half of western treatment. Her tongue was deviated 45 degrees, she drooled from her sagging mouth, she lost the ability to say certain words and her balance was off. In a single session I straightened her tongue, which held at least seven years. Her mouth and eyes lifted to normal levels. Her balance improved. Had she come earlier I might have been able to recover speech, but she at least was able to start relearning. No metaphysics. No Orientalism. Just good physical medicine.

    Chinese herbal medicine has been used for centuries with some of the most obsessive case histories written by major doctors which were dissected and discussed by doctors through the ages. The balance of treatments to root causes, symptoms and associated body areas has a sophistication not easily found in pharmaceutical medicine today, for all its often skewed studies. I personally had cellulitis treated by a Sun Si Miao formula that is over 500 years old. It worked when the eminent doctor devised it, and it has continued to work. It would not have been recommended for centuries if it didn’t.

    As a practitioner of Oriental Medicine, with four years of postgraduate training and clinical internships, I have very little interest in woo. I have skills that heal that I learned from eminent doctors of the past like Zhong Zheng Jing (the Hippocrates of China) and doctors of the present. Your ignorance of the real traditions of Chinese medicine lead you to ridicule the pretenses of laypeople and to ignore the meat of the tradition.

  10. Ben Kavoussi says:

    Dear Karen,

    Thank you for your enlightening remarks. Coincidently, my next post is about acupuncture brothels, since the Los Angles Times has recently reported (June 3, 2009) that 22 women have been arrested in Vista, CA, after an undercover investigation into prostitution at day spas and acupuncture parlors!

    With such “happy-ending” treatments, no one can depute the efficacy of acupuncture, the wisdom of the eminent doctors of the past, and the unparalleled “skills” of acupuncturists today, who in a single session can lift up many physiological processes to normal levels. As for my ignorance of the real traditions of Chinese medicine, I consider it a blessing in disguise, for it has so far saved me from prosecution and imprisonment…

  11. mike150160 says:

    It’s deja vu all over again:

    1 Thoughtful, referenced post from SBM member
    2 Assertion from woo-meister of efficacy of particular brand of woo
    3 Attempt to back up claim with either: a) cherry-picked study with limited subject numbers and/or self-limiting condition, or more likely b) anecdata
    4 Thoughtful, referenced reply from SBM showing lack of efficacy, no relationship with anatomy and/or physics and requests for rigourous data
    5 claim of conspiracy from woo-meister coupled with a cry of “I know it works”

    rinse, repeat

    You know, I kind of miss Pec…

  12. pmoran says:

    “People who would have responded to the placebo effect of western medicine, if that is all it were, respond to acupuncture after other treatment fails.”

    English doctors have a wise old saying: “Blessed is he who treats the patient LAST”.

    It refers, in part, to the fact that most common complaints get better eventually and the last treatment resorted to gets the credit. With some conditions a brief placebo response to an empathic practitioner may be enough to tilt patients out of illness mode.

    So I, for one, am fairly confident that you are helping some patients, and possibly also in ways that may not be readily accessed within the local conventional medical scene, — yet certainly far less than you think in strictly medical terms.

    I don’t believe, for example, that acupuncture can cure long standing lingual and facial paralysis. Would you care to ask that patient if you can provide confirming details about her, perhaps a name, and a medical contact? This story does not seem to be listed among the testimonials on your web site, which contain fairly standard, often very short-term testimonials, all obtainable with any good placebo delivered by a confident practitioner.

    Also patients have been shown to value medical attentions very highly even when they have little impact in basic illness measurements. Medical interactions soothe many human needs.

  13. Dacks says:

    Although I have no belief in the efficacy of acupuncture, I think this post draws overly broad connections between any ideas the author sees as countercultural. We have

    “revolutionary ideas mixed with environmentalism; organic farming and the avoidance of pollution, agrochemicals and pharmaceuticals; nonconformism and alternative lifestyles; a syncretistic mix of psychedelic drugs, Eastern religions and Native American spiritualities; the resurgence of the taste for mystic, occult, and magical phenomena;6,7 and the belief in the existence of a separate and non-ordinary reality, as upheld by one of the fathers of the New Age movement, Carlos Castaneda…”

    all thrown in together as reasons for the public’s acceptance of acupuncture.

    In case that isn’t enough, our problems are also caused by “collective amnesia about lancing and bloodletting, and the belief in the existence of pneuma,” “continued postmodern opposition to Enlightenment rationalism,” and, finally, by “the idea that Eastern cultures have crucial characteristics directly and unequivocally opposite to the West is a Western construct that “exotices” the East while neglecting considerations of power.”

    This is a stone-soup argument, which doesn’t lend itself to careful review. In addition, it is hard to believe that the crazy ideas and ideologies of the 1970′s are causative of the upsurge in medical woo seen in the past ten or fifteen years.

  14. Yes, there is a trend or a fad that people are seeking out oriental medicine and accepting its effectiveness without due diligence, but remember that for the past 100+ years there has been a trend or a fad of people only accepting western medicine without any due diligence. But perhaps this excitement over this new fad is just part of a natural order of things. The excitement that occurs when people’s eyes have been opened. When people can see the great possibilities that didn’t exist before.

    As for the effectiveness of oriental medicine. Let’s first start off with understanding that the WHO, the National Institute of Health and the British Medical Association all endorse acupuncture as an effective form of treatment. I hope you believe that these organizations are swayed more by research than emotion.

    Remember also that acupuncture has only been researched for the past 2 decades. Also important is the lack of money being poured into acupuncture research. Truth is that studies proving that acupuncture works don’t make anybody rich, unlike studies regarding pharmaceuticals.

    Lastly, my hope is not that oriental medicine replace “modern” medicine, but rather that MD’s and the rest of the medical establishment learn to play nice and work together with other health care practitioners. A patient that has a wider range of treatment available is surely more likely to find health.

  15. Harriet Hall says:

    Ken Shim said, “A patient that has a wider range of treatment available is surely more likely to find health.”

    Is a patient who adds ineffective treatments to effective ones more likely to find health?

  16. daedalus2u says:

    PM, I think that paralysis of some types can be remarkably improved by placebo treatments. I have an extensive blog post on fever therapy. That was the “standard of care” for the paralysis of neurosyphilis for decades.

    http://daedalus2u.blogspot.com/2008/01/resolution-of-asd-symptoms-with-fever.html

    A placebo can’t repair nerve damage, but if the functional connectivity is impaired due to neuroinflammation, then resolution of that inflammation can produce acute improvements. I think that is what is happening with fever therapy. Nitric oxide from iNOS raises the NO level in the brain sufficiently to “switch” the brain to a high NO state from the low NO state of neuroinflammation. The change in NO levels may be very small, less than nM/L.

    I think this acute resolution of symptoms of neuroinflammation is the physiology behind the perispinal injection of Etanercept causing acute resolution of symptoms of Alzheimer’s.

  17. pmoran says:

    “PM, I think that paralysis of some types can be remarkably improved by placebo treatments. I have an extensive blog post on fever therapy. That was the “standard of care” for the paralysis of neurosyphilis for decades. ”

    Fever therapy is not clearly only a placebo when used for this condition.

    Also this early medical practice is not likely to have been based upon quality evidence. Prospective randomized clinical trials were very rare before the middle of the last century and double blinding is an even later evolution in them.

    (Bear this in mind, folks, when Dr Mercola and other AM dignitaries resurrect old research in furtherance of nutty claims. )

  18. billga says:

    I think the core issue is this. Medicine has succeeded best in relieving suffering caused by bodily disorder. Disease, pathology if you like. Abnormal processes in the body which can be documented. Think cancer, kidney failure etc. No other approach comes close to offering relief from such afflictions. Where medicine (and to my eye all other approaches) has largely failed is in the realms of distress, illness, call it what you will where there is (yet) no demonstrable pathology, disease, bodily disorder. Here the alternative approaches have a field day. None of them work all that well but neither does conventional medicine. Think mental illness.
    This does not suggest we should abandon a rigorous empirical science approach, it suggests we need to stop playing around with nonsense and work a bit harder at the problem.

  19. daedalus2u says:

    PM, you are right, fever therapy is not a placebo treatment per se, but the raising of NO levels is part and parcel of both the placebo effect and of fever therapy.

    Stress reduction is a placebo, a physiological change produced by non-pharmacological means. Stress reduction will (I think) cause a slight improvement in post-stroke paralysis in some individuals. The opposite treatment (stress increase) will make it worse (but is harmful so it can’t be ethically tested experimentally, but anecdotes of abuse seem to corroborate the idea that it does). I think the physiological mechanism is the increased functional connectivity due to increases NO levels in the brain.

  20. woo-fu says:

    I started reading SBM for reasonable, scientific responses regarding alternative medicine and studies related to its efficacy. This post, however, was disappointing in that it seemed to devolve into ideological warfare and petty insults, highlighted by the response to Karen’s comments. Furthermore, questions regarding the possible value of at least some of the techniques listed as adjunct therapy, either in terms of physical therapy or psychological therapy, were largely ignored.

    Is this a forum where science and reason are employed to analyze the various topics clustered together under the CAM umbrella, or is this a forum that assumes from the outset that everything under that umbrella is worthless, dooming objective analysis? If intended to be the former, contributors would be more effective if they kept the insults out of the discussion.

  21. daedalus2u says:

    woo-fu, SBM requires prior plausibility and a demonstration that the effect being studied is real and not what Dr. Hall calls “Tooth Fairy Science” and what Feynman called “Cargo Cult Science”.

    Belief in acupuncture did not derive from an honest and scientific study of qi and meridians followed by clinical trials that showed acupuncture to be an effective way to unblock qi and produce healing effects. People looking at acupuncture now are not looking at it with a fair and skeptical mind. When studies show equivalent effects from acupuncture with needles and toothpicks in the right and wrong places, what that shows is that the foundation of acupuncture, the factual existence of qi and meridians has no explanatory or predictive power. It is disingenuous to simply claim that “toothpicks work too”.

    SBM doesn’t assume all CAM is worthless. The default hypothesis of SBM is that treatments with no plausible physiological mechanism behind them are implausible. To overcome that default hypothesis you have to have data or theory that shows it works, or that shows a plausible physiological mechanism by which the treatment might have a physiological effect. So far, the only plausible mechanism behind acupuncture is the placebo effect.

    If CAM does have positive effects, those effects must be mediated through physiology. The way to understand the physiology of CAM is through studying things scientifically, which means first ensuring that what you are studying actually exists. That means studying physiology, not studying ancient texts, meridians and qi.

  22. Skeptico says:

    Karen Vaughan:

    You can make areas of the brain that affect migraines light up on a MRI by using the associated acupuncture points on the toe, or areas that affect the lower back light up by needling the back of the knee. Radioactive isotopes injected into acupoints follow meridians

    Evidence to support those claims?

    I had a client who suffered from a bad stroke and came after a year and a half of western treatment. Her tongue was deviated 45 degrees, she drooled from her sagging mouth, she lost the ability to say certain words and her balance was off. In a single session I straightened her tongue, which held at least seven years. Her mouth and eyes lifted to normal levels. Her balance improved. Had she come earlier I might have been able to recover speech, but she at least was able to start relearning. No metaphysics. No Orientalism. Just good physical medicine.

    Actually, just an anecdote.  Nice try though.

  23. Skeptico says:

    Ken Shim, RMT:

    Remember also that acupuncture has only been researched for the past 2 decades.

    Really?  Then how did the ancient Chinese know about it, if it wasn’t researched when they discovered it?  How did they know?

  24. alison says:

    On Karen’s claim that radioactive tracers move along meridians from acupuncture points and Skeptico’s asking for proof, there is a recent study on MRI imaging and acupunture – a feasibility study on the migration of tracers after injection at acupoints of small animals. Sorry if most of the address below is superfluous – this is what appeared in the subject line when I had the abstract loaded.

    I have read the full article – until about a month ago it would download as a pdf – but now you have to pay for it.

    http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B985H-4WW268T-8&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=996241563&_rerunOrigin=google&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fcd61959d9690486b5fdc4cc54208f4a

    Some pertinent points:

    The study was done in Korea, on rats and mice.

    The paper begins by stating as unquestioned fact that the meridians are known to be the channels on the body in which qi flows.

    There are images of the animals showing how the tracer moved in their bodies after injection. I am not a TCM expert by any means but I do know where the meridians are supposed to run in four-legged animals. What you see on the images is not movement along these narrow channels but a more general diffusion.

    I recall the authors saying that much of the tracer ended up in the liver and kidneys, and that this showed that it had gone to the organs associated with the meridian that had been injected (which was Bladder, in this case). It doesn’t seem particularly surprising that injected substances should show up in these particular organs: is that not what you would expect as the body deals with them and then excretes them?

  25. Zetetic says:

    DACKS said:

    “…it is hard to believe that the crazy ideas and ideologies of the 1970’s are causative of the upsurge in medical woo seen in the past ten or fifteen years.”

    My Baby-Boomer generation is SO into alternative medicine and the roots really do go back to the 1970′s hippie era! At least in my circles, a dinner party conversation in my age group isn’t complete without some sort of anecdotal testimony about acupuncture, herbal remedies and teas, chiropractic visits, mystic massage therapy, etc. The nebulous aches, pains and minor ailments of encroaching old age are very well served by the placebo effect of Integrative/CAM treatments. Most of this circle is college educated but other than my wife and I, largely non-science educated.

  26. woo-fu says:

    daedalus2u, I’m not sure I made my point very well. I really appreciated Dr. Kavoussi’s last post on acupuncture, and I’m with you that treatments need to begin with a reasonable theory based on observable phenomena. I also agree that before science accepts any practice as medically valid, well-designed, rigorous studies need to be carried out and replicated.

    I’m not disputing any of these necessities of science. However, this post has lumped together so many other techniques, social movements, etc. along with criticism of acupuncture, in an effort to show they’re all part of the daisy chain of woo. It’s here I think the valid criticisms get muddled. I also feel the tone of antagonism regarding some of the comments clouds the picture. The point, pardon the pun, gets lost.

    Finally, regarding some of the other techniques listed, I feel that there may be psychosocial benefits beyond placebo effect that get overlooked. And regarding the physical practices, some may well have a place in exercise and physical therapy, even if the wilder health claims associated with them are unsupported.

  27. Ben Kavoussi says:

    I thank everyone for their interesting comments. I would like to point out to the obstinate supporters of acupuncture that what is described in the ancient classics of medicine in China is not acupuncture as we know it today, but lancing and bloodletting. Please refer to my post called “Astrology with Needles” on this site for further details.

    I just learned that Paul Unschuld’s translation of the Yellow Emperor’s Classic will be out soon. Hopefully it will be an eye opener for acupuncture advocates, since–according to Paul Buell–the acclaimed classic appears to be more of a compendium of myth, magic and astrology than a true medical text.

    Also, puncturing the skin at specific to affect specific organs or to mitigate specific diseases is not uniquely Chinese or Far-Eastern. Such practices even existed in the Mesoamerica. Actually, for most of China’s long history, needling, bloodletting and cautery were marginal practices associated with folk-healing, amulets and talismans, and considered a lower class of therapy than the use of pharmacopoeia.

    The “eminent doctors of the past like Zhong Zheng Jing” did not use acupuncture, they relied on pharmacopoeia. But the willfully-ignorant and irresponsibly-deceitful practitioners of woo, who often pose as primary healthcare providers, want us to believe that the reclaimed astrology they have learned from New Age gurus is a scholarly medical tradition of China. The claim that nonsense-with-needles can miraculously treat poststroke symptoms in one session is utterly foolish and preposterous.

  28. Dacks says:

    Zetetic – Where was alt med in the 80′s, or early 90′s? Pretty minor, in my memory. I think some of these practices would have died out if not for DSHEA and CAM friendly legislators.

    Yes, the hippies did embrace lots of weird things. But I think this article falls very short on showing real connections between a hodge-podge of wacky beliefs and the recent upsurge in alt med.
    Kavoussi should leave the social science interpretations to someone with more expertise.

  29. daedalus2u says:

    woo-fu, as I understand the physiology, all “psychosocial benefits” derive through the same physiological pathways as placebos and are indistinguishable from placebos. To me they are placebos. For example, I see psychotherapy as a placebo, quite an effective placebo, one that I was willing to pay for out of pocket for decades with no regrets.

    I think the bringing up of so many different CAM treatments modalities, even those that are not recognized as such, is not inappropriate. They are fundamentally all the same, elaborate placebos. The way to study them is to look at the final common pathways between them and other placebos. I think the success of CAM relates more to the adoption of a successful business model for CAM delivery rather than any particular utility for CAM.

    To understand why there is such a seeming epidemic of CAM, one has to understand the background of why CAM is adopted in the first place. It is adopted for disorders which don’t have good SBM based treatments and which are amenable to treatment by placebo. These happen to be mostly disorders characterized by a low basal NO level. There are no generally recognized methods for increasing NO levels. This is because NO physiology is under extremely tight physiological control. It is difficult to perturb, and extremely difficult to perturb without causing adverse side effects.

    The physiological placebo effect is one way to raise basal NO levels. The “effect” isn’t in the placebo; it is in the individual whose physiology is triggered by that placebo to raise its NO level.

  30. Ben Kavoussi says:

    Dear Karen,

    Practitioners of “Oriental Medicine” in the US do not have “four years of postgraduate training and clinical internships,” as you claim.

    They have non-academic vocational degrees that are not regionally accredited, something like cosmetology or medical assisting degrees. Although an “Oriental Medicine” diploma might say “Masters Degree” on it, it is only a vocational degree, and the vocational training consists of hundreds of hours of ancient metaphysics on imaginary structures called “Meridians,” and on astrological notions such as the “yin-yang” or the “5-Elements” theories. They only have minimal training in modern biomedical sciences, sometimes less than what is required from a licensed vocational nurse.

    Claiming that the practitioners of “Oriental Medicine” in the US have postgraduate training is irresponsibly dishonest.

  31. thanson says:

    Ben,

    Karen did not claim that “practitioners of ‘Oriental Medicine’ in the US” have “four years of postgraduate training and clinical internships,” as you claim. She only said that she is a practitioner and that she has four years of postgraduate training, etc. As a medical student with a graduate degree in analytic philosophy, I have do disagree with your reading. (Note that I have used the same phrasing that Karen used, but it is also clear that I am not claiming that all medical students have graduate degrees in philosophy). Come on, Ben.

    Here are some references for a few papers that discuss how different parts of the brain get activated in very targeted ways by acupuncture, as well as discussion of possible physiological explanations. There is real science behind some aspects of acupuncture, and not everyone who endorses acupuncture does so on the basis of “ancient wisdom.” I had hoped there might be a substantial discussion of this on this blog. If these papers are junk, I would be grateful it if someone could tell me why.

    Subcutaneous Tissue Fibroblast Cytoskeletal
    Remodeling Induced by Acupuncture:
    Evidence for a Mechanotransduction-Based Mechanism
    J. Cell. Physiol. 207: 767 – 774, 2006

    Acupuncture Analgesia: I. The Scientific Basis [review article]
    Anesth Analg 2008;106:602–10

    Neuronal Specificity of Acupuncture Response:
    A fMRI Study with Electroacupuncture
    NeuroImage 16, 1028 –1037 (2002)

  32. woo-fu says:

    “woo-fu, as I understand the physiology, all “psychosocial benefits” derive through the same physiological pathways as placebos and are indistinguishable from placebos. To me they are placebos. For example, I see psychotherapy as a placebo, quite an effective placebo, one that I was willing to pay for out of pocket for decades with no regrets.”

    Daedalus2u, I disagree that the effects of psychotherapy are due to placebo. If you have evidence that the physiological effects of the discipline are the same as placebo, I would like to examine it.

    In my experience, psychotherapy’s best effects are the result of actual cognitive processing. In good psychotherapy one learns about his/her own thoughts and behaviors and their impact on relationships, and the impact of relationships on one’s thoughts and behaviors. As these are understood, a person ideally learns how to change these habits and/or relationships to his/her benefit. No learning is involved by taking a sugar pill.

    Regarding all the social commentary in this thread, perhaps Dacks is correct in asserting that social science interpretations should be made by someone with more expertise.

  33. Ben Kavoussi says:

    Dear Dacks,

    This post is not about alternative med in the 80’s or 90’s, or the hippie’s hodge-podge of wacky beliefs. It is about a 20th Century Maoist construct called Traditional Chinese Medicine (TCM), or Oriental Medicine that has been legitaimated in the last decades in the US, and is now represented by several professional and educational associations and their attorneys and lobbyists.

    The reality is that there is no such a thing as TCM or Oriental Medicine. There are thousands of different–and often antagonistic–health and safety beliefs in China, ranging from shamanism to medical astrology and humoral pathology. Please read my post on medical astrology on this site. Some of these beliefs that were consistent with Marxist dialectics were sanitized and homogenized during the Maoist era and combined with biomedicine to create a makeshift healthcare system, and also to train the “Barefoot doctors.” Please refer to Kim Taylor’s book, Chinese Medicine in Early Communist China, 1945-63: A Medicine of Revolution (RoutledgeCurzon, 2005). David W. Ramey, DVM, write that the book is a historical account of the evolution of this “great charade.”

    Oriental Medicine is a modern invention, one that is being rejected by the modern Chinese, even as has been embraced by many wishful Westerners who have bought into the Maoist nonsense.

    I hope this clarifies things.

  34. Ben,

    You are correct that many in the west have romanticized and simplified the story of the history of Chinese medicine. Yes, there were conflicting theories and practices and yes, recent political shifts in China put their stamp on this subject and yes, many Chinese are turning toward things western and rejecting their own culture’s ideas, but you do a disservice to this complex subject by only focusing on those aspects of a more than 2,000 year story that support your campaign against Chinese medicine. Let’s see where science is at in 1,500 years and see if there were ever any disagreements over that period. 2,000 years is a long time and people disagree. It is not hard to find disagreement over such a period.

  35. daedalus2u says:

    woo-fu, my definition of a placebo is any treatment that does not involve pharmacology or surgery; in other words any treatment that doesn’t do something “material”.

    A treatment that is mediated by communication (i.e. psychotherapy) is (to me) a placebo simply because it doesn’t have a pharmacological or physical basis behind it.

    It is very important to define “placebo” in a way other than by its effects. We know that stress reduction can have remarkable healing effects. Those effects are not produced through a pharmacological treatment, so they are placebo. Placebos sometimes work. You can’t have a definition of “placebo” that only applies when treatments are ineffective. There are plenty of non-effective pharmacological treatments. We don’t call them placebos. Similarly when a mother kisses a boo-boo and the child feels better, we don’t attribute curative properties to her saliva.

    I am happy to use another definition, but there needs to be a term for treatments with positive health effects that are not mediated through pharmacology or surgery.

  36. Ben Kavoussi says:

    Dear Thanson,

    Thank you for your comments. Believe it or not; I am a licensed acupuncturist with a degree in Oriental Medicine. I therefore know the licensing requirements of acupuncturists in the US.

    Karen clearly states that she has “four years of POSTGRADUATE training AND clinical internships.” There are no four-year postgraduate training and clinical internships in acupuncture in the US. I therefore reminded her, and everyone lese, that practitioners of “Oriental Medicine” in the US do not have four years of POSTGRADUATE training AND clinical internships … If this is not dishonesty, I don’t know what is.

    All well–conducted trials must have 3 arms. One is no intervention, one is the control group and one is the intervention group. In acupuncture studies one group gets nothing, one group gets needling at irrelevant points and one gets at “true” points. All well–conducted acupuncture studies show that there are no statistically significant differences between the control group and the intervention group. Both groups, however, do better that the no intervention group. This means that it does NOT matter where you place the needles, as long as it is safe. This is the whole point of these posts. This is something that only those who understand clinical trials seem to understand.

    The fMRI studies in acupuncture are not 3-arm studies. Is the area lighting up in the fMRI due to specific needling, or due to pain and inflammation caused by needle insertion that could be placed anywhere in the body? In my opinion, it would be absurd to argue that fMRI studies lead to something else than clinical trials. The effect shown must therefore be due to the needling alone, and irregardless of the meridian-and-point nonsense, which derives entirely from astrology.

    For further details, please read my post called “Astrology with needles.”

  37. Ben Kavoussi says:

    Dear Alison,

    The meridian-and-point system is entirely based on astrology.

    Please refer to my post on this subject.

  38. Ben Kavoussi says:

    Dear Mathieu,

    My intent is to deconstruct and expose misrepresentation and deceit in CAM.

    What was practiced in China 2000 is not acupuncture as we know it today but a type of bloodletting. Reading Chinese medical classics in light of modern acupuncture is an anachronism. Acupuncture with thin needles, as you practice it, is a product of 20th Century.

  39. alison says:

    Dear Ben

    Waah – I’ve been misunderstood! I know that chi, meridians and points are imaginary. Just because I know where they are ‘supposed’ to be doesn’t mean I believe in them. In my post I was saying (a) that the authors of that paper made unwarranted assumptions as a basis for their work: it is ridiculous to begin a purportedly scientific paper with the statement that meridians are known to exist, and (b) that the results didn’t show what they thought – or wanted – them to show because the scans didn’t show the tracer moving along definite lines through the body. Which adds up to saying that the study didn’t amount to anything, as one generally finds when looking up the references cited by CAM prsons to support their beliefs. Sorry if I gave the impression of being a believer myself. Heaven Forbid! to use an astrological expression. I read your articles to get better at arguing with my true-believing friends.

  40. Ben Kavoussi says:

    Hi Alison,

    Sorry about the confusion. Yes, indeed, there are thousands and thousands of biased studies, most of them come from Asian countries. If you want to know more about what is fundamentally wrong with acupuncture studies, please read Barker Bausell’s book, Snake Oil Science: The Truth about Complementary and Alternative Medicine (Oxford University Press. 2007). Please let me know if you have any questions concerning the acupuncture-astrology connection.

  41. Ben –

    While it is true that some scholars have postulated that the idea to penetrating the skin with needles as a means of therapy may have had its roots in bleeding techniques, no scholar stands firmly on this theory because there is not a shred of hard evidence to support it. When you use the term “bloodletting” you are invoking images of the dangerous technique used for hundreds of years in the West. When one looks at the oldest book on acupuncture theory, the at least 2,200 year old Yellow Emperor’s Classic, one finds nothing resembling this technique. There are techniques that call for superficially pricking the skin at specific spots and squeezing out a few drops of blood, but the Chinese would never encourage taking large quantities of blood as was practiced in the West. The Chinese viewed the blood as too vital to ever encourage draining large amounts.

    Furthermore, the vast majority of the 365 points noted in the Yellow Emperor’s Classic do not lend themselves to “bloodletting” at all as they are nowhere near veins that would avail themselves to that technique. And as far as your claim that fine needles were unknown until recently, this same book also describes the “Nine Needles” including the “Hao” needle that was very fine and was the inspiration for the later filiform needle.

    Come-on, Ben. You should know very well that the Western practice of “bloodletting” is nothing at all like the Chinese practice of “bleeding.” Your trying to link the two as a way of discrediting acupuncture may make points with the uninformed but only underscores your lack of creditability with those familiar with this subject.

  42. Ben Kavoussi says:

    Dear Mathieu,

    The great French philosopher and scientist René Descartes is credited to have recommend reading a text over-and-over if you have difficulties understanding it.

    I clearly write that “Initially, according to the classical Greek procedure, blood was let from a site near the location of the illness but later physicians drew a SMALLER amount of blood from a DISTANT site.”

    The more I read the arguments presented by acupuncturists, the more I see that their obstinate devotion to the nonsense-with-needles has all the characteristics of the willful ignorance seen in ultra-orthodox cults.

    Reading my article Astrology with Needles one more time might help understand the link between acupuncture and bloodletting.

  43. “RESPECT MY AUTHORITY!”

    Cartmen

    Ben,

    Your willful ignorance of acupuncture’s unarguable track record of helping people often with greater benefit and far less harm than science based medicine convinces me that you represent a small but vocal minority of science supporters who care more about the authority of the institution of science than the people that institution is supposed to be serving.

    But you are right, I think of myself as part of a cult. The cult dedicated to helping those suffering.

  44. daedalus2u says:

    Matthew, 2000 or even 200, or even 100 years ago your statement “helping people often with greater benefit and far less harm than science based medicine” may have been correct. It isn’t correct now.

    Your cult isn’t dedicated to helping those suffering; it is dedicated to avoiding the narcissistic injury that acupuncture practitioners will experience by admitting they were wrong and acupuncture is just a placebo. Avoiding narcissistic injury is one of the main mechanisms that keep cults together.

  45. Harriet Hall says:

    Matthew Bauer said,
    “Your willful ignorance of acupuncture’s unarguable track record of helping people often with greater benefit and far less harm than science based medicine”

    We know about acupuncture’s track record, but we can’t distinguish it from the simliar track record of placebos.

  46. Ben Kavoussi says:

    Well said daedalus2u, well said!

  47. Skeptico says:

    Well, it’s been nearly a week and neither Karen nor Ken have responded to my questions.  I guess it’s easy to claim that specific areas of the brain light up to specific acupuncture needling, or that radioactive isotopes injected into acupoints “follow meridians” etc.  Not so easy to back up those claims.  Alison did have a good summary of one study – noting that is it hardly surprising that injected foreign substances ended up in the liver and kidneys.  Nice one Alison.  Kevin / Karen: thanks for playing.

    Ben did at least try to respond with a couple of papers he’d found:

    Here are some references for a few papers that discuss how different parts of the brain get activated in very targeted ways by acupuncture, as well as discussion of possible physiological explanations. There is real science behind some aspects of acupuncture, and not everyone who endorses acupuncture does so on the basis of “ancient wisdom.” I had hoped there might be a substantial discussion of this on this blog. If these papers are junk, I would be grateful it if someone could tell me why.

    Subcutaneous Tissue Fibroblast Cytoskeletal
    Remodeling Induced by Acupuncture:

    Evidence for a Mechanotransduction-Based Mechanism

    J. Cell. Physiol. 207: 767 – 774, 2006

    This one does not in any way “discuss how different parts of the brain get activated in very targeted ways by acupuncture.”  All it shows is that if you stick needles in the skin and rotate them, there are physiological effects on nearby cells. Well whoopee doo, big surprise. Actually, it would only have been surprising if sticking in needles had no effect on nearby cells. 

    Furthermore, this paper specifically states that you get the same effect from other manipulation of the skin – for example by massage:

    The fibroblast spreading induced by needle rotation was similar to that previously reported with stretching of subcutaneous tissue together with dermis (Langevin et al., 2005), showing that two different types of mechanical stimuli (tissue stretch and acupuncture) caused similar subcutaneous tissue fibroblast morphological responses. Thus, connective tissue mechanotransduction responses may be common to different types of therapeutic interventions using externally applied mechanical forces (e.g., physical therapy, massage, and acupuncture).

    “Meridians” were not even mentioned once in the paper. That’s a pretty resounding yawn for acupuncture, in my view.

    Acupuncture Analgesia: I. The Scientific Basis [review article]
    Anesth Analg 2008;106:602–10

    Just some pain reduction for sticking in needles (some of which included electrical stimulation – which is not acupuncture).  Many studies did not include sham acupuncture – so no control group. Nothing to support the theories of acupuncture. In fact they state:

    The traditional Chinese perspective is not based on anatomical, physiological, or biochemical evidence, and thus cannot form the basis of a mechanistic understanding of acupuncture. Western theories are primarily based on the presumption that acupuncture induces signals in afferent nerves that modulate spinal signal transmission and pain perception in the brain.

    IOW, it might stimulate the production of endorphins. Again, big surprise – sticking needles in has a small physiological effect. Nothing about “meridians” or “targeted” applications. 

    Neuronal Specificity of Acupuncture Response:
    A fMRI Study with Electroacupuncture

    NeuroImage 16, 1028 –1037 (2002)

    The title says it all – “Electroacupuncture.”  This is not acupuncture.  If they are applying electric current through the needles then they are merely mimicking transcutaneous electrical stimulation (TENS), which is not acupuncture, but is an accepted therapy supported by actual evidence.  Plus the study only had 15 subjects – no where near enough to show “significant” differences, as they claim.

    IOW, standard acupuncture bullshit – weak studies, small numbers of subjects, insufficient controls, confounding factors such as electrostimulation, irrelevant factors being measured, trivial conclusions (eg sticking needles has a physiological effect) being touted as profound etc etc.

  48. Skeptico says:

    Sorry, that should have been thanson, not ben, who quoted the studies I replied to above.

  49. Ben Kavoussi says:

    Dear Skeptico,

    Yes, indeed, electroacupuncture is not acupuncture, and thank you for bringing this up. Unfortunately, there is an amalgamation between both modalities amongst the acupuncturists, and also in some slate laws that regulate the practice of acupuncture.

  50. woo-fu says:

    Thank you for this clarification about electroacupuncture. The individual I commented on in the Astrology with Needles post who I thought had benefited from acupuncture–as compared with the others, myself included, who did not–actually had this procedure, electroacupuncture, instead. I double-checked the details about this person’s treatment after reading the most recent comments here.

    We had no idea such different techniques were both being advertised as “acupuncture.” It certainly confuses the issue of efficacy but seems a boon to marketing. The other thing that bothers me is how many acupuncturists, at least in my area, mingle so many techniques together in one visit that it would be extremely difficult, should a positive effect be perceived, to determine the cause, placebo or not. The same would be true of adverse reactions. It becomes difficult to know where to put the blame.

    When I felt I had experienced adverse reactions, mostly allergic skin reactions, the acupuncturist rather nastily denied there were any adverse reactions related to the practice. Rather, I was told I would have to get worse before I got better and that if I couldn’t handle that, I should stick with taking pills. I searched online to find examples in the medical literature, which included metal allergies among other problems, and forwarded them; however, I doubt if this changed the acupuncturist’s opinion.

    Too much certainty one is always right can be very problematic and downright dangerous.

  51. sstumpf says:

    I thought I might something about acupuncture research with NO which is beyond my comprehension but I hope will be reviewed by the “acupologists” and scientists for my own benefit. At least one of the authors is a Chinese national who is a strong advocate for acupuncture. He has dedicated a considerable amount of his academic career (UCLA Medicine) investigating the neurochemical foundations of acupuncture. While he would like to prove the existence of meridiens I am not certain he believes in qi. Among other investigations, he traces the presence of NO along meridiens. He is a fascinating scientist who would only consider scientific proof sufficient evidence. Here is his most recent reference on PubMed.

    Jou NT, Ma SX. Responses of nitric oxide-cGMP release in acupuncture point to electroacupuncture in human skin in vivo using dermal microdialysis. Microcirculation. 2009 Jul;16(5):434-43. Epub 2009 May 26.

    What I am getting to follows. The investigator has a counterpart at UCI who has also published substantially on acupuncture research. His area of expertise is cardiology. Here is his most recent reference.

    Tjen-A-Looi SC, Li P, Longhurst JC. Processing cardiovascular information in the vlPAG during electroacupuncture in rats: roles of endocannabinoids and GABA. J Appl Physiol. 2009 Jun;106(6):1793-9. Epub 2009 Mar 26.

    Two Chinese national scientists with cultural roots in acupuncture. One believes in qi and meridiens. The other does not. One is dedicated to proving meridiens exist. The other has made up his mind on the woo woo but is dedicated to scientifically documenting and explaining how acupuncture works.

    Both share the strong unequivocal belief that reliance upon the “classics” of Chinese Medicine and the post-Maoist emergence of TCM have nothing to do with acupuncture efficacy. Their dispute remains in the world of science. They conduct well-designed research (best I can tell) and publish in peer-reviewed US journals as well as Chinese journals (I cannot say whether their Chinese pubs are peer-reviewed). They have been working like this for more than a decade. They have appointments at major academic medical centers (pardon my bias).

    In my experience discussions with acupuncture leaders/thinkers never reveal any knowledge of these two authors/researchers or any other acupuncture researchers working in biomedical science. Furthermore, these leading theorists and advocates of acupuncture as an ancient healing art rarely evidence much knowledge of their emic counterparts whose arguments can be both science-based as well as historical. Ben mentions Paul Unschuld’s forthcoming translation of the classic text which typically forms the foundation of every TCM claim to fame. This will certainly be interesting as Unschuld is a widely published scholar on Chinese Medicine who just does not buy the woo woo. He has contemporaries such as Kendall, Schnorrenberger, Ullett and more recently Kavoussi.

    And as long as TENS has been mentioned what about the very interesting modern era emergence of acu-alternatives including TENS, PENS and trigger point therapies? I would find it intriguing to read Bauer’s and woofu’s and alison’s views on what these scientists/thinkers have to say. I believe I am sufficiently informed on the magic, mystery, 2000 years of history, and anecdotal puff ‘n stuff. Somebody please tell me what the two cited references conclude and if their research designs make sense.

  52. daedalus2u says:

    sstumpf, interesting, I could only see the abstract. I think I understand what they are doing and reporting. They are looking at local NO production by nitric oxide synthase by looking at nitrate plus nitrite in the extravascular fluid by dialysis,(putting a tube under the skin that collects fluid from the extravascular space by diffusion and collecting that fluid by pumping a collecting fluid through it). Any type of inflammation or irritation that produces any type of vasodilation or local reddening would probably exhibit increased NOx via this test. The NOx they looked at is only a measure of NO production rate, it is not a measure of NO concentration. This is a very important point that many NO researchers miss.

    The NOx is collected by the lymph and can have systemic effects. That is the essence of what I am doing with my bacteria. They generate nitrite from the ammonia in sweat which is absorbed through the skin (very fast, less than a minute) and has systemic effects. Nitrite is pretty non-specific (but has a lot of beneficial effects for diverse health conditions, i.e. reliably reduces infarct size in MIs (as an aside, I think that is the reason for sweating during shock, to supply ammonia to a biofilm of my bacteria)).

    Systemic nitrite might not have the same effects as NO/nitrite on the skin because the skin is pretty much hemoglobin free, so there can be free NO in the skin, and that NO can attach to albumin and form S-nitrosoalbumin (which is the major S-nitrosothiol in the blood and is a major NO/NOx species). NO can be transnitrosated from S-nitrosoalbumin to other thiol containing proteins, even across cell membranes (protein disulfide isomerase does this).

    I think the amounts of nitrite that would be produced by this acupuncture mechanism are too small to have systemic effects (but without seeing the numbers I can’t be sure). Nitrite is also generated by reduction of salivary nitrate (concentrated 10x over plasma) on the tongue by commensal bacteria. There is a fair amount of research on this and there is considerable thought that a large part of the beneficial health effects of eating green leafy vegetables is from the nitrate they contain (few tenths of a %). That is well absorbed and ~100 grams of lettuce can result in nitrite levels in saliva of ~2 mM/L which can have measurable systemic effects on blood pressure and platelet stickiness.

    I looked at some of the other papers suggesting NO involvement with acupuncture and electroacupuncture. They may be right. NO is a neurotransmitter, it could be involved in multiple ways by the stimulation of needles, electrodes and even toothpicks and even placebos. They did some work with electroacupuncture and looked at NOx in rat brains and found it. The involvement of the CNS is very suggestive of placebo effects as is the requirement that individual experience

    The properties attributed to qi have some vague similarities to what I would expect from NO/NOx species transported in lymph, and I have been thinking about this for a while. There is not a one-to-one correspondence and most of the properties attributed to qi are non-real and sorting that from what might be physiologic is difficult and not very useful in understanding either NO or acupuncture or placebos.

    There are two TCM concepts zhishen and deqi.. Zhishen is considered to be “gaining full control over the patient’s spirit”, while deqi is the physical sensations felt by the person receiving the needling that indicates that the needling is successfully activating what ever it is supposed to activate. Triggering that sensation is probably a powerful placebo in people conditioned to accept it as therapeutic, particularly when in a suggestible state where the acupuncturist is in “full control” of your spirit.

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