The Cargo Cult of Acupuncture

Bloodletting, of course, was a major aim of early vessel therapy and is frequently described in the Su wen.1

Paul U Unschuld

“Cargo cult” is a metaphor that describes the act of imitating an activity or a practice without any insight into the underlying principles. In the literal sense, it refers to a magico-religious practice observed in tribal societies, where the members ritually imitate the activities of a technologically-advanced society they had contact with, so that they can magically draw their material wealth. For instance, after WWII, indigenous tribes in New Guinea who had come in close contact with cargo planes, started to build landing strips and populated them with plane-like effigies that were made of straw, bamboo, and coconuts, so that they can magically lure the passing planes.2 The term “cargo cult science” was introduced by Richard Feynman in a speech at Caltech in 1974 to describe pseudoscientific studies in which all the superficial aspects of a scientific inquiry are adhered to, but the underlying principles are not scientific. He classified many educational and psychological studies as such, for having the appearance of academic research but lacking the principles of a scientific inquiry.3

Another example of cargo cult science is the plethora of two-arm acupuncture studies that compare a needling regimen using the traditional concepts, and compare it with a non-interventional placebo. These studies might have the appearance of clinical research, but they are inherently flawed and inconclusive, because they do not rule out the possibility that the observed results are mainly due to the painful stimulus and injury caused by a needle, which can occur regardless of the insertion point. Indeed, an acute noxious stimulus from a prickle, heat, or any other painful stimulus – almost anywhere on the skin – can attenuate the perception of pain in another area of the body through a reflex called “counter-irritation,” also called the “pain-inhibiting-pain effect” or “diffuse noxious inhibitory control” (DNIC).4 DNIC was extensively studied by Fauve et al. in the 1980s, who showed in mice that it has an effect equivalent or superior to that of glucocorticoids.5,6

Counter-irritation has been known since antiquity, and is at the base of many noxious folk remedies, such as the application of cautery, blistering and moxibustion (the burning of dried Artemisia annua on the skin) to name but a few, whereby “one pain masks another.”7 These modalities were once widely used, generally in an attempt to reduce inflammation.9 It is therefore plausible that the nonspecific effects observed in some types of acupuncture are also linked to DNIC, since some authors have reported that acupuncture is only effective in producing analgesia when the stimulation itself is of a sufficient intensity to cause an unpleasant sensation. The DNIC induced by needles is believed to be mediated by the release of endogenous opioid neuropeptides and/or monoaminergic neurotransmitters, mainly because naloxone, a central and peripheral opioid receptor antagonist, is reported to reverse its effects.10,11 A true interpretation of this finding invalidates the traditional lore of the meridian-and-points system, and indicates that any needling regimen can lead to outcomes associated with DNIC. This finding echoes the position of Felix Mann, MD, the founder of the British Medical Acupuncture Society, who after decades of practice reached the conclusion that putting needles in “wrong” places was as effective as a “correct” treatment. He therefore wrote that “traditional acupuncture points are no more real than the black spots a drunkard sees in front of his eyes.”12

There is also credible evidence that the stimulation of a myofascial trigger point (TrP), meaning a localized, hyperirritable nodule nested within a palpable taut band of skeletal muscle or fascia,13 can evoke short-term anti-nociceptive effects on the same segmental dermatome.14 This local hypoalgesic effect is reported to be greater than stimulation at remote dermatomes.15 It is based on this finding, that Janet Travell, MD, (1901-1997) began needling hyperirritable points with syringes in in the 1940s, injecting them first with procaine.16 Procaine was later replaced by saline solution,17 which was later replaced by “dry needling” (TrP-DN ) — without any fluid in the syringe.18,19 Although the dermatomal distributiosn of anti-nociceptive effects do not correspond to the distribution of the Chinese meridians, they do affect the outcome of two-arm studies because any needling regimen in the same dermatome should lead to similar results. Therefore, two-arm studies cannot rule out the possibility that the observed results are due to anti-nociceptive effects on the same segmental dermatome, which can occur regardless of the classical theories for point selection and means of stimulation.20

In addition, both laboratory and clinical evidence have recently shown the existence of two-way interactions between the nervous system and the innate immunity. There is experimental evidence showing that percutaneous and transcutaneous neurostimulation can inhibit macrophage activation and the production of pro-inflammatory cytokines.21 Kevin J Tracey, MD and his collogues at Feinstein Institute for Medical Research have shown that an increase in the production of Acetylcholine (ACh) can inhibit the synthesis of TNF and other pro-inflammatory cytokines in organs rich in cells of the monocyte-macrophage system.22 Tracey argues that Ach interacts with members of the nicotinic ACh receptor (nAchr) family, in particular with the alpha-7 subunit (α7nAchr), which is expressed not only by neurons, but also macrophages and other cells involved in the inflammatory response.23 It is therefore conceivable that the anti-inflammatory actions that have been associated with needling – and have been used to justify the traditional concepts of acupuncture – are directly or indirectly mediated by neurostimulation and inflammatory macrophage deactivation, and can occur with transcutaneous or percutaneous neuromodulation anywhere proximal to nerves.24 This is consistent with the hypothesis of George A. Ulett and Songping Han, who argued that certain effects of needling, especially in the ear, might be explained by a “broad parasympathetic effects” due to the stimulation of vagus nerve, which also innervates the ear.25 Again, two-arm studies cannot rule out the possibility that the observed results are due to the broad neurostimulatory effects of needling, and regardless of the needling regimen.

In sum, for the reasons stated above, two-arm acupuncture studies that compare a traditional regimen with a non-interventional placebo are inherently inconclusive. I would further argue that the regimen used in these studies is not even reflective of the traditional methods, because the loci of cautery, blistering, cupping, moxibustion and acupuncture might have been selected simply because they were particularly sensitive and painful, and the alleged analgesic and anti-inflammatory effects of traditional regimens are not achievable by the “soft needling” technique used in clinical studies today. These studies unequivocally use quasi-unperceivable, painless, filiform, silicon-coated needles for ethical reasons and to prevent dropouts. This type of “acupuncture without tears” amounts to what Arthur Taub has suitably called “nonsense with needles.”26

Finally, the most compelling argument to qualify acupuncture of a cargo cult, is the fact that its apostles remain obstinately faithful that someday, someone will prove that “astrology with needles” is a panacea that can naturally restore health and longevity. This is despite the fact that well-conducted three-arm clinical trials that used sham controls with needle insertion at “wrong” points (points not indicated for the condition) or non-points (locations that are not known acupuncture points) along with a non-interventional control group, have failed to demonstrate that there is a reliable difference between sham and “true” needling. Three well-designed three-armed randomized controlled clinical trials with 302, 270, and 1007 patients, respectively, have demonstrated that acupuncture and sham acupuncture treatments were more effective than no treatment at all, but there was no statistically significant difference between true and sham acupuncture,27,28,29 suggesting that it does not have unique effects on the central nervous system, or on pain and pain modulation.30 These studies indicate that the “meridional theory” is of low importance, and does not lead to specific therapeutic effects.31,32 The most recent challenge came from a review article in the New England Journal of Medicine which concluded that acupuncture’s specific therapeutic effects – if any – are small, and its benefits are mostly attributable to “contextual and psychosocial factors, such as patients’ beliefs and expectations, attention from the acupuncturist, and highly focused, spatially directed attention on the part of the patient.”33

I see the pointless studies that aim to validate notions that date of Galen’s era, and hear the irrational narrative of the apostles of this cargo cult at the twilight of a dying hope, and I think of Baudelaire’s morose elegy to “The Swan:”

A swan which from its cage had made escape
Patting the torrid blocks with webby feet,
Trailing great plumes of snow, while beak agape

Tumbled for water in the parching street;

Wildly it plunged its wings in dust again,
Mourning its native lake, and seemed to shrill:
“Lightning, when comest thou? and when, the rain?”
Strange symbol! wretched bird, I see it still.

Charles Baudelaire (1821 – 1867), Flowers of Evil

1. Unschuld PU. Huang Di Nei Jing Su Wen: Nature, Knowledge, Imagery in an Ancient Chinese Medical Text. University of California Press. 2003
2. Lawrence P. Road belong cargo: a study of the Cargo Movement in the Southern Madang District, New Guinea. Manchester University Press, 1964.
3. Feynman RP. Surely You’re Joking, Mr. Feynman! (Adventures of a Curious Character). W. W. Norton & Company. 1997.
4. Follett K. Neurosurgical Pain Management. Elsevier Health Sciences. 2004
5. Fauve RM, Fontan E, Hevin MB, Saklani H, Parker F. Remote effects of inflammation on non-specific immunity. Immunol Lett. 1987;16(3-4):199-203.
6. Fauve RM. Endogenous counterinflammation and immunostimulation [in French]. Pathol Biol (Paris). 1987;35(2):190-194.
7. Wand-Tetley JI. Historical methods of counter-irritation. Ann Phys Med 1956;3:90–8
8. Le Bars D, Dickenson AH, Besson J-M, Villaueva L. Aspects of sensory processing through convergent neurons. In: Yaksh TL, ed. Spinal afferent processing. New York: Plenum, 1986: 467–504.
9. Holden AV, Winlow W. The Neurobiology of Pain: Symposium of the Northern Neurobiology Group, Held at Leeds on 18 April 1983. Manchester University Press. 1984.
10. Pomeranz B, Chiu D. Naloxone blockade of acupuncture analgesia: endorphin implicated. Life Sci. 1976;19:1757-1762.
11. Zhou ZF, Du MY, Wu WY, Jiang Y, Han JS. Effect of intracerebral microinjection of naloxone on acupuncture- and morphineanalgesia in the rabbit. Sci Sin. 1981;24:1166-1178.
12. Mann F. Reinventing Acupuncture: A New Concept of Ancient Medicine. Butterworth-Heinemann; 2 edition. 2000.
13. Simons DG. Review of enigmatic MTrPs as a common cause of enigmatic musculoskeletal pain and dysfunction. J Electromyogr Kinesiol 2004; 14: 95–107.
14. Srbely JZ, Dickey JP, Lee D, Lowerison M. Dry needle stimulation of myofascial trigger points evokes segmental anti-nociceptive effects. J Rehabil Med. 2010 May;42(5):463-8.
15. White PF, Craig WF, Vakharia AS, Ghoname E, Ahmed HE, Hamza MA. Percutaneous neuromodulation therapy: does the location of electrical stimulation effect the acute analgesic response? Anesth Analg. 2000 Oct;91(4):949-54.
16. Travell J, Rinzler S, Herman M. Pain and disability of the shoulder and arm: treatment by intramuscular infiltration with procaine hydrochloride. JAMA. 1942;120:417-422.
17. Sola AE, Kuitert JH. Myofascial trigger point pain in the neck and shoulder girdle. Northwest Med. 1955;54:980-984.
18. Kraus H. Clinical Treatment of Back and Neck Pain. New York, NY:McGraw-Hill; 1970.
19. Dommerholt J, Huijbregts P. Myofascial Trigger Points: Pathophysiology and Evidence-Informed Diagnosis and Management. Jones & Barlett Learning. 2009.
20. Baldry PE. Acupuncture, Trigger Points and Musculoskeletal Pain. Edinburgh, UK: Churchill Livingstone, 2005.
21. Wang H, Yu M, Ochani M, et al.Nicotinic acetylcholine receptor alpha7 subunit is an essential regulator of inflammation. Nature. 2003;421:384-8.
22. Tracey KJ. The inflammatory reflex. Nature. 2002;420:853-859.
23. van Maanen MA, Vervoordeldonk MJ, Tak PP. The cholinergic anti-inflammatory pathway: towards innovative treatment of rheumatoid arthritis. Nat Rev Rheumatol. 2009 Apr;5(4):229-32.
24. Tracey KJ. Physiology and immunology of the cholinergic antiinflammatory pathway. J Clin Invest. 2007;117(2):289-296.
25. Ulett GA, Han S. The Biology of Acupuncture. St Louis, MO:Warren H. Green; 2002.
26. Taub A. Nonsense with Needles. In Barrett S and Jarvis W. The Health Robbers: A Close Look at Quackery in America. Prometheus Books, Amherst, NY. 1993. Article available online at
27. Linde K, Streng A, Jurgens S, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes MG, Weidenhammer W, Willich SN, Melchart D. Acupuncture for patients with migraine: A randomized controlled trial. JAMA 2005;293:2118-2125.
28. Melchart D, Streng A, Hoppe A, Brinkhaus B, Witt C, Wagenpfeil S, Pfaffenrath V, Hammes M, Hummelsberger J, Irnich D, Weidenhammer W, Willich SN, Linde K. Acupuncture in patients with tension-type headache: Randomised controlled trial. BMJ 2005;331(7513):376-382.
29. Scharf HP, Mansmann U, Streitberger K, Witte S, Kramer J, Maier C, Trampisch HJ, Victor N. Acupuncture and knee osteoarthritis: A three-armed randomized trial. Ann Intern Med 2006;145:12-20.
30. Campbell A. Point specificity of acupuncture in the light of recent clinical and imaging studies. Acupunct Med 2006;24(3):118-122.
31. Moffet HH. Sham acupuncture may be as efficacious as true acupuncture: a systematic review of clinical trials. J Altern Complement Med. 2009 Mar;15(3):213-6.
32. Moffet HH. Acupuncture trial lacks a priori rationale to refute null. hypothesis. Arch Intern Med. 2008 Mar 10;168(5):550-1.
33. Berman BM, Langevin HH, Witt CM, et al. Acupuncture for chronic low back pain. N Engl J Med 2010 Jul 29; 363(5):454-61.
34. Shanks LP. Flowers of Evil. Ives Washburn. New York, 1931.

Posted in: Acupuncture, Medical Academia, Science and Medicine

Leave a Comment (21) ↓

21 thoughts on “The Cargo Cult of Acupuncture

  1. windriven says:

    Welcome back. Nice to see that your blog has returned.

    Can you address why some of the nation’s premier medical schools offer acupuncture programs? And how is it that medical doctors can become board certified in acupuncture?

    Is medicine a science and/or evidence based profession or is it a marketing program that asks, “what would you like on your pizza today?” How can health care consumers be expected to negotiate appropriate health care choices when mainstream medical schools and hospitals offer acupuncture and worse?

    In these columns we read complaints all the time about chiros and others running outrageous sCAMs. How is the MD community different? It is one thing to have a few outlier MDs off in the weeds, quite another to have weed-ology taught at Yale.

  2. cervantes says:

    Okay, but what this says to me is that what I’ll call “inacupuncture” might actually have value for pain relief and even reduction of inflammation. (Actually we already do use it, topical capsicum for pain relief.) Perhaps it makes sense to bag the meridian and Qi nonsense, but actually do some rational research into this modality, no?

  3. Following the cargo cult metaphor, I’ve often wondered if acupuncture carries the illusion of legitimacy because it’s penetrative in a way that other cam modalities are not. Acupuncturists use needles just like real doctors!

  4. davenoon says:

    But there’s the rub. I doubt there are many folks who would agree to “[bag] the meridian and Qi nonsense” and then submit to being speared with needles out of a vague understanding of how “counter-irritation” works. As Kavoussi explains at the very end of the piece, whatever small therapeutic benefits exist for acupuncture, they’re due to “contextual and psychosocial factors.” Acupuncture survives because people believe in magic and miracles. If the Insane Clown Posse have taught us nothing else, it’s that these people don’t want to know how the f*cking magnets work.

  5. Josie says:

    Isn’t pain in a different body area still pain?

    My Mom used to tease me whenever I would come home with skinned knees and elbows that she would make me feel better by taking a hammer to my big toe!

    And no, she did not hammer my toes, but she did make me laugh and that too had a sort of pain lessening effect.

    I can see using this sort of modality when there are no other options, but now we have drugs that target the source of pain response and work to stop that signal.

    I’ll take the tried and true approach –ie one with a scientific basis and not just ..err poking around.

  6. Ian says:

    @Josie: pinching myself while getting a cavity filled makes me feel better, even with the Novocaine. :D

    I’m sure there are many types of chronic pain where the kind of pain you get from a prick would be much preferred.

  7. Canadian Curmudgeon says:

    @ ian: I’m sure there are many types of chronic pain where the kind of pain you get from a prick would be much preferred.

    I’d try that instead of needles anyday :)

  8. cloudskimmer says:

    Josie wrote “I can see using this sort of modality when there are no other options, but now we have drugs that target the source of pain response and work to stop that signal.”

    Sadly, pain medications have undesirable side effects, and often don’t help patients with pain. Chronic pain patients are constantly in search of a solution, finding people who say they can help, and then the pain returns, and they repeat the process again and again. That’s why acupuncture, chiropractic, and even modern medicine can appear so effective. Most people do get better, so every ‘treatment’ can appear to work, at least temporarily.

    Do any pain medications ‘target the source of pain response”? If so, why do so many patients fail to get relief from their pain? Facet joint injections, done by M.D.s to address back pain would seem to fall into this category, but also seem not to work over the long-term.

  9. Ben Kavoussi says:

    Dear windriven,

    Thanks for your insightful comments. Physicians have become interested in acupuncture and are becoming certified due to (1) healthcare consumerism, (2) publications by mainstream and reputable organizations (which are mostly flawed if we know the astrological origins of acupuncture), (3) availability of grants, (4) New Age ideology, and the belief that science is just one the many possible narratives about reality. Val Jones and Harriet Hall have both written many posts on these subjects. Please also take a look at my post “Oriental Medicine or Medical Orientalism?”

    In my upcoming post I will address the issue of Orientalism in research by using as an example a flawed research at a mainstream university which has found a rationale for the meridian-and-point fantasy. This study (and the likes) provide false credibility to acupuncture’s traditional theories. You are right, unsuspecting health care consumers cannot truly negotiate appropriate health care choices. This is why we have this site, and this is why I write to deconstruct this New Age cargo cult.

  10. Ben Kavoussi says:

    Dear cervantes,

    Yes, “inacupuncture” (I like the term!) is being used. For instance, Kevin J Tracey, MD, of North Shore-LIJ Health System has been working on strategies to sedate the innate immunity for pain relief and the reduction of inflammation by neurostimualtion, using chemical or physical approaches. This is indeed “inacupuncture” via PENS and TENS to stimulate “hard-wired” neural systems. Please refer to Tracey’s article in Nature called “The Inflammatory Reflex:”

  11. Ben Kavoussi says:

    Anthropologist Underground,

    In my next post I will show drawings from medieval China which indicate that acupuncture with fine needles as we know it today has never existed. What was practiced in China is apparently lancing, bloodletting and surgery, when you consider the tools described in medical manuscripts that today are being published as manuals of acupuncture! These tools are very similar to the ones used by the barber-surgeons in Europe…

    As you can see, the resemblance with needles used by real doctors, is something new…

    The illusion of legitimacy is multifold!

  12. Ben Kavoussi says:


    Thanks for the comments. You just put your finger on something fundamental to CAM, especially acupuncture: “willful ignorance.”

    Many people, like Felix Mann and George Ulett have convincingly argued from the beginnings that the meridians and points business is based on fantasy. Very few people in the US have listened to them.

    We have done all this research; people have based their academic careers on it; we have acupuncture centers at major universities; we have legitimated and legalized the practice of medicine based on the meridians and points system, and now we are discovering that whatever small therapeutic benefits exist for acupuncture, they’re due to “contextual and psychosocial factors!” No kidding!

    We were willfully ignorant for socio-economical reasons.

  13. Ken Hamer says:

    “I’m sure there are many types of chronic pain where the kind of pain you get from a prick would be much preferred.”

    What if it was Andrew Wakefield?

  14. drmarcelli says:

    If we tried to convince the most skeptical of our friends that in the top right part of his abdomen there was a dark reddish brown organ called the liver, he would answer: prove it!
    First we would give our friend an ultrasound scan, explaining to him that ultrasound waves hit his liver and bounce back as echoes, which are converted by the computer into the images he is now seeing on the computer’s screen: the capsule of his liver, its lobes with the annexed biliary tree and gall bladder.
    But if after this test he were still incredulous, because we have not demonstrated the dark reddish brown color of his liver at all, we could take him to witness a post-mortem, which would erase all his doubts.

    In the same way, if we told him that, according to the acupuncture meridians theory, his thumb is connected to his lung and the second toe to the stomach, he would certainly ask us for a demonstration for these new claims as well.
    Then we would promptly show him one of the dozen charts of the acupuncture meridians we possess. We would point our finger to the lines drawn over the skin, which start from the thorax and face, pass through the lung and stomach, and end at the thumb and second toe, just as we declared.
    And what if our friend commented that we were philosophizing on raw drawings that prove nothing? And what if he defiantly said he could draw similar lines connecting the lung to the little finger instead of to the thumb, and the stomach to the big toe instead of to the second toe?
    After this criticism, would he be satisfied if we said that the meridians were drawn by the great doctors of the past and that proof of their existence is logically deducible from the clinical effectiveness of acupuncture?
    Would he believe studies prove that the stimulations of the points on those lines cure diseases of the lung and stomach better than those of the bladder and pancreas?
    What simple and immediate test like the ultrasound scan could we give him to provide our claims with a convincing rationale? What indisputable evidence like an anatomical dissection could we put under his very eyes to demonstrate that acupuncture meridians really exist?

    The sole experiment I know, which repeated on a large scale and resulted true for all meridians could really reopen the discussion on the acupuncture’s state of non-evidence is reported in this article:

  15. Dr. Le Petomane says:


    Very interesting (at least from my fairly cursory read) and apparently worth more investigation. However, even if there is some hitherto unknown physiologic basis for meridians, there is resoundingly NO serious evidence for the clinical efficacy of poking them with needles for anything.

    It also begs the question of how preindustrial Chinese researchers could have created an accurate map of meridians without the advanced technology it has taken for anyone to have a remotely credible claim to have detected them.

    If the authors of this study are onto something (and I’ll leave investigation of that to someone with more time and patience than I have), that puts them at about the stage of Galen (2nd and 3rd century AD)–some good facts, but not much clue as to why they are true and what to do about it.

  16. wertys says:


    Siegfried Mense in Germany to name just the most long-term researcher in the filed has done exemplary basic science into muscle and deep soft tissue nociception, and it is largely his work that informs our current understanding of myofascial pain and other types of soft tissue pain. When you understand the body of work that exists to explain how deep somatic irritation from any cause increases DNIC, and how in syndromes like myofascial pain and fibromyalgia syndrome DNIC becomes inefficient in response to deep somatic pain triggers, you realize just how much acupuncture proponents are like a cargo cult. I think the title was an inspired choice, as I am sick and tired in my day job in the pain clinic going over how specious and logically flawed the arguments in favour of acupuncture really are.

    On a lighter note, a physiatrist called Peter Dorsher drew attention to the overlap between myofascial trigger points and ‘acupoints’ with a meticulously researched
    He was following up the same idea from a long time before in this paper..

    The resulting vitriolic responses from traditional acupuncturists were hilarious reading

  17. wertys says:

    With regard to the idea of ‘trying anything’ for chronic pain when no medical treatments are working, this only makes sense of you accept the allopathic/alternative false dichotomy.

    As a doctor working within an interdisciplinary team, I can testify to the harm that is done, inadvertently and through ignorance of the facts, to allowing long-term sufferers of chronic pain to continue to believe that the best approach to their pain is found within a medical (or indeed a pseudomedical) paradigm. The evidence-based approach for many sufferers of long-term pain is to help them make emotional and practical adjustments and teach them the proven techniques for living successfully with their pain. We do this knowing that most of our patients do not want to hear this, and we accept that their frequent rejection of our best advice is also part of the process. We are, however ethically bound to make them aware of the best available evidence in the field, and provide treatment in accordance with that evidence.

    So my perspective boils down to the following….when a problem is not amenable to a simple medical transaction, one does not seek to substitute substandard treatment for the gold standard, even though the best, most effective and safest treatment is not something the patient has ever considered, and may require of them major changes to previously unchallenged beliefs. Putting up alternatives like acupuncture, homeopathy and all the other sCAMs enables the prolongation of the state of denial and maladaptive coping that traps so many pain sufferers and causes so much of the preventable disability.

    Gone on a bit long, but hopefully my comments may provide some food for thought amongst my commenting brethren…

  18. Scott says:

    That is indeed a very interesting angle on things, wertys. Very worthy of careful consideration.

  19. Ben Kavoussi says:


    Thank you for your comments and for bring up the emotions debate arising from the claims of overlap between myofascial trigger points and ‘acupoints’ . I would argue that the reactions from traditional acupuncturists indicate that their view is intertwined with devotions and adoration…something similar to reactions seen in religious debates!

  20. So I totally lifted (with attribution) your cargo cult medicine meme and applied it to homebirth in the US here.

  21. Ben Kavoussi says:

    @ Anthropologist Underground,

    Thank you very much. Please stay tuned for another post on acupuncture.

Comments are closed.