Back in May 1998 a systematic review of published results from clinical trials and the country they are published in was, well… published.
Two studies were conducted. In one, trials in which the outcome of acupuncture was compared to placebo, no treatment or a non acupuncture intervention were studied. In the second study randomised, controlled trials (RCT) of non acupuncture interventions in China, Japan, Russia/USSR, or Taiwan were compared to those published in England. Regarding the study of acupuncture:
Research conducted in certain countries was uniformly favorable to acupuncture; all trials originating in China, Japan, Hong Kong, and Taiwan were positive, as were 10 out of 11 of those published in Russia/USSR.
It was also found that trials in the second group were skewed to produce favourable results in China [99%], Japan [89%], Russia/USSR [97%], and Taiwan [95%]. In England, “75% gave the test treatment as superior to control”.
No trial published in China or Russia/USSR found a test treatment to be ineffective.
Conclusion: Some countries publish unusually high proportions of positive results. Publication bias is a possible explanation. Researchers undertaking systematic reviews should consider carefully how to manage data from these countries.
In 2010 a systematic review of systematic reviews of acupuncture for depression stated in part:
Acupuncture is often advocated as a treatment for depression, and several trials have tested its effectiveness. Their results are contradictory and even systematic reviews of these data do not arrive at uniform conclusions. The aim of this review is to critically evaluate all systematic reviews of the subject with a view of assisting clinical decisions. […]
All the positive reviews and most of the positive primary studies originated from China. There are reasons to believe that these reviews are less than reliable. In conclusion, the effectiveness of acupuncture as a treatment of depression remains unproven and the authors’ findings are consistent with acupuncture effects in depression being indistinguishable from placebo effects.
So on top of favouritism to acupuncture in certain countries, notably China, there is also an overlay of unusually high results. Indeed as shown in many studies and reviews initial study design and publication bias in Asian countries favours acupuncture efficacy. A few minutes searching will confirm this over and again. Thus, we can confidently be skeptical about studies raised in defence of acupuncture and stand firm that it’s “success” stems from study design and publication bias.
Yet, there’s also the issue of mythology and outright fallacies presented time and again regarding acupuncture’s origins. Appeal to antiquity is a major thought stopper when it comes to how acupuncture works and the other hanky panky around “forces” and “energy flows”. Consider:
Acupuncture is a traditional technique developed over two thousand years ago based on the insertion of needles or more recently electrical stimulation, based on the Chinese medical theory that diseases are caused by blockages in the ﬂow of energy within the body.
We can rather swiftly expose that story as a patently modern day fake. Some scam artists know that acupuncture as we know it, is only a few decades old. In reputable organisations or conventional medical service providers where it is offered, a cleverly worded non committal pitch, seems to please legal advisers whilst keeping the mystique alive. I particularly like this one from Arthritis M.D.:
Acupuncture is one of the key components of the traditional Chinese medicine system. Chinese medicine was documented in China in the 3rd century B.C. This system views the body… Traditional acupuncturists also believe… According to Chinese medicine… As acupuncture has evolved and spread across countries and continents, different acupuncture points have been reported. Chinese theory…
It’s one of the very few that acknowledge (but do not admit) the fallacious creation of the vast majority of the more than 2,000 acupuncture points, or acupoints. There was originally 365 to correspond to days of the year. But thanks to Western marketing, bogus diploma courses, bad science and general unaccountability manifesting in mock up journals things got more convoluted and sciency. So what are the problems with the story of a 2,500 year old therapy? Fortunately other sciences can explain.
We’re asked to believe that the technology to make needles far thinner that hypodermic needles existed around 500 BCE. Just on that, Reflexologists claim a history of up to 5,000 years in their appeal to antiquity. Historiologically this is absurdity on steroids, even out-dating Moses by 1,600 years.
Earliest Chinese texts are from 3rd century BCE, and no mention of any needling is in evidence. By 90 BCE needling of infected wounds and bloodletting was reported. Archeological and anthropological evidence is robust and unambiguous. Needles used were huge. It was not until the 1600s that the technology to manufacture acupuncture needles existed. So, immediately we’re down to a generous 400 years.
In 1680 the ﬁrst Western accounts of Chinese medicine [TCM was introduced by Mao in the 1960s] by Wilhelm Rhijn did not mention acupuncture points,”qi” or energy ﬂow. Needles were shoved into wombs and skulls for “thirty respirations”.The USA did try this technique for drowning victims from 1826, reporting 100% failure and that they “gave up in disgust”. Western reports of “acupuncture” from around the early 1900’s mention not one word of the practice we’re today told is 2,500 years old. Most tellingly there are no points, qi or meridians in these reports.
In fact, it mirrored mechanical nociceptor stimulation and endorphin release, with needles jabbed into sites of pain. By the 1900s, “Qi” is still “vapour emitted by, or arising from food”. Meridians are still inert vessels/channels with no bodily association. So, we’re down to a few decades – but how few?
Enter… The French. Georges Soulie de Morant coined the usage of “meridian” to justify his belief that energy or “qi” moved throughout the body. He is the ﬁrst properly documented human being to make that link. It was 1939. However, we had to wait until 1957 until another Frenchman, Paul Nogier, invented auricular acupuncture. Note this is not today’s acupuncture, nor the claimed ancient method. It is the notion of unseen energies. Similarly, today we hear much of non existent “toxins” where once we heard of disease carrying “Miasmas”. Some others in France accept this concept. Most French doctors claim this is “resurrecting an absurd doctrine from well deserved oblivion”.
So in respect of this practice supposedly a part of Chinese history, we’re down to 53 years, have no scientiﬁc or medical community support and seem to be nowhere near China. Also the Traditional Chinese Medicine [TCM] phrase is yet to exist also. Why? Interestingly enough, the only nation to strive to ban the acupuncture (of large needles jabbed into wounds, skulls and wombs) was China, between 1822 and WWII, under the Chinese Nationalist Government. Post Communist Revolution, Mao was faced with the reality of infection and disease as the few remaining Western or Soviet trained doctors worked in cities in a nation where 80% of the population was rural. An immediate problem for Mao was wide spread schistosomiasis. Vikki Valentine writes:
One of the Party’s first steps in medical reform called for massive campaigns against infectious disease. Thousands of workers were trained and sent out into the countryside to examine and treat peasants, and organize sanitation campaigns.
Enter his “Barefoot Doctors” who provided cheap and dangerous “alternative medicine”, and demonstrated the power of the Peoples Party when ordered to physically catch all fresh water dwelling snails capable of passing on the schistosoma parasite responsible for schistosomiasis. Ten million residents suffered from this and peasants called it “Big Belly”.
The schistosoma parasite when infectious swims about happily until it encounters a human. Then it burrows into the skin and becomes a schistosomula. It then sets up camp in the lungs or liver to mature.
Adults then infect the lungs and liver and also set off to invade the bladder, rectum, intestines, the portal venous system which carry blood from the intestines to liver, spleen, and lungs. Symptoms include seizures and the swollen belly.
A major platform of the Communist Party was a revolution in agriculture. A “Great Leap Forward” was needed in China. But Party leaders, including Chairman Mao Zedong, knew that improving the health of peasants was integral to increasing agricultural production.
What followed was a backlash against Western-style “elite” medicine. The “bourgeois” policies of “self-interested” physicians who only treated rare and difficult diseases were denounced as “disregarding the masses.”
Mao was pleased with reports that the disease was wiped out in up to 95% of areas where it had been endemic. He claimed his party could “cure what the powers above have failed to do”.
Mao’s government coined the term “traditional Chinese medicine” – TCM – including herbal medicine, crude acupuncture, moxibustion and more in the 1960’s. Mao himself despised the notion, never using any “TCM”. Vested interests had little trouble manufacturing an entire fake history which – ironically – we in the West could access with ease, from a nation practically able to suppress the ﬂow of air, much less information.
Chinese do not use the TCM we have invented here in The West. In 1995 a group of visiting American medico’s were informed between 15-20% of Chinese use herbal medicine. Almost no Chinese medicine is used in and of itself but with mainstream medicine. It is considered a sign of poor class and ignorance by the Chinese in general to use any “TCM”.
The Australian Acupuncture and Chinese Medicine Association offer a celebration of meaningless “qualiﬁcations”, codes of ethics and standards, all carefully crafted by themselves. So, what’s happening within this multi-billion dollar industry that need face no medical tribunals, provide data nor adhere to Australian Medical Standards?
Today it is a Western marketing success that grew following Communist Dictator Mao’s smirking at – then – superior economies. Unable to apply widespread Western medicine, alternatives were used. The West was assured this was successful and superior. We were scammed via our own gullibility about the far East and The Orient, still are by the Wellness Industry and China has indeed had the last laugh. Acupuncture produces a documented placebo effect. If you think youʼre getting it, it works, whether you are, or not. Itʼs you, the recipient who does this “mystical thing”. Harriet Hall writes in Science Based Medicine:
In the best controlled studies, only one thing mattered: whether the patients believed they were getting acupuncture. If they believed they got the real thing, they got better pain relief – whether they actually got acupuncture or not! If they got acupuncture but believed they didnʼt, it was less likely to work. If they didnʼt get it but believed they did, it was more likely to work.
Acupuncturists can rationalize with great ingenuity. In a recent study using sham acupuncture as a control, both the sham placebo acupuncture and the true acupuncture worked equally well and were better than no treatment. The obvious conclusion was that acupuncture was no better than placebo. Their conclusion was that acupuncture worked and the placebo acupuncture worked too!
Certainly there are ancient practices involved in the modern TCM plaguing the growing hokus pokus that constitutes the “Wellness Industry” yet acupuncture is not one of them. What we have today is not a 2,500 year old practice but a relatively modern expression of bad science derived from archaic ignorance that’s been very recently polished and refined to seem like genuine therapeutic intervention. At it’s very best acupuncture may well be responsible for releasing endorphins. It is a placebo and thus as a reliable mode of treatment is utterly and absolutely useless.
Of course many herbs can have demonstrable effects. In truth those that do are few and regulation is poor. Contamination with mercury, arsenic and lead is common whilst interaction with genuine drugs can lead to serious adverse reactions. All TCM must be regarded as harmful in that it delays access to efficacious evidence based treatment and is buoyed by the deceptions or well meaning but erroneous beliefs of practitioners. Proponents are welcome to subject their “medicine” for clinical trials, yet time and again they emerge as alternatives to medicine.
To argue there has been an unbroken chronology of superior “natural” therapies is simply false. It’s a common myth proffered by the Wellness Industry. Archaeology is absolute in producing evidence that humans have for many thousands of years died much, much younger and from painful chronic diseases that were quite simply beyond treatment. Diseases we today do not encounter in developed nations. Like any alternative to medicine acupuncture cannot survive RCT except to emerge time and again as placebo.
Australia would do well to review how much we spend on education and insurance for this slick ritual.