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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.

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