Acupuncture: Cures or cures?

Acupuncture is steeped in many legends. It has been attributed miraculous powers to cure diseases ranging from allergies and depression to infertility, paralysis and cardiovascular disease. But does acupuncture really work?

Acupuncture is one of the key trends in traditional Chinese medicine, where special needles are injected into certain points on the human body. According to the proponents of this method, such intervention is supposed to improve health and well-being. In some Western countries, such as the USA, acupuncture has been rapidly gaining popularity as a form of alternative medicine in recent years. Acupuncture is being used to treat a wide range of ailments, from pain and nausea (for example, after chemotherapy or radiotherapy for cancer treatment) to allergies, depression and infertility. It was previously thought that acupuncture could be used to treat facial nerve palsy, allergies, some skin and cardiovascular diseases and sciatica.

But before declaring something as a method of treatment, it is necessary to carefully check whether it helps or harms, in what amounts and to whom it should be recommended, and most importantly, to explain the principles of the method. The effectiveness of some methods is confirmed by newer and neater studies, the effectiveness of others is partially, and others are not at all.

Trust, but verify!

History knows many cases when modern scientific methods have confirmed the effectiveness of medicines of unconventional medicine. Even Hippocrates suggested taking ground willow bark to relieve pain and fever. For the same purpose, willow bark was used by some Indian tribes in North America. The bark was later found to contain the active ingredient salicylic acid.

Modern aspirin is a derivative of salicylic acid (acetylsalicylic acid), a less active form that is metabolized into its active form (salicylic acid). So aspirin is a successful example where alternative medicine was not wrong. That is why it is successfully used in modern medicine. Another example is the use of cinquefoil bark by Europeans, beginning in the 17th century, to treat malaria. It turned out that this bark contains quinine – an effective remedy for malaria plasmodium, the causative agent of malaria. There are many such examples in the history of medicine, but still they are the exception rather than the rule.

On the other hand, for thousands of years and until the 20th century, many doctors practiced bloodletting to treat almost any disease, from asthma to cancer, from plague to scurvy. As we know today, in most cases this “treatment” did more harm than good. In the first half of the 20th century, people actively used “rejuvenating cosmetics” containing radium salts, and in general, the newly discovered radiation was called “the rays of life” and considered a cure for all diseases. Before the research of Marshall and Warren, who received the Nobel Prize in Medicine in 2005, it was believed that stomach ulcers were caused by stress or consumption of spicy foods. We now know that the most important factor causing stomach ulcers is the bacterium Helicobacter pylori, and that ulcers can be treated with antibiotics. Another Nobel laureate, Linus Polling, was a strong proponent of the idea that colds could be prevented and even treated by consuming large amounts of vitamin C. However, when this claim began to be carefully tested, it turned out that the effect of vitamin C, if any, was very small and of no therapeutic value.

Finally, there is increasing attention in modern medicine to the fact that, due to individual genetic characteristics, different medications may have different efficacies for different patients. The aforementioned acetylsalicylic acid appears to significantly reduce the risk of colorectal cancer, but not in all people, but only in people with certain variants of certain genes, as a team of researchers led by Hongmei Nan of the University of Maryland School of Medicine has shown.

Thus, scientific ideas about the effectiveness of medical interventions are not standing still. Do we need to reconsider our knowledge about the effectiveness of acupuncture in light of new and neater scientific research, or will it perhaps confirm our earlier beliefs?

Acupuncture – Alternative Medicine

The relationship between alternative and conventional medicine is beautifully described by the Australian actor and comedian Tim Minchin: “What is alternative medicine? – It’s medicine that’s either been proven not to work, or it’s not known if it does or doesn’t work. – What do you call alternative medicine if it’s been proven to work? – It is simply called “medicine.” The main problem with the theoretical justification for the supposed effectiveness of acupuncture has been that it has always been unclear how it can work. We stick needles in – so what? The needles are acting on special lines – meridians – along which “life energy” circulates? And what is this life energy, who and how discovered it? Hardly such, to put it mildly, unscientific answer can satisfy scientists in the XXI century.

Placebo is not magic, but reality.

Over the past few years, we have become well aware that we should not underestimate the placebo effect. What is it? In brief: a person expects that some medicine or exposure will give him relief, relaxes, his brain releases special substances (such as endorphins), which lift the mood and reduce pain sensations. No magic – simple physiology.

A number of studies have shown that the strength of the placebo effect depends on the way the pseudo-drug is administered. For example, injections of saline have a stronger effect than sugar pills. In recent years, numerous studies have shown that the strength of the pills depends on their color, as well as on the claimed price of the pills and even the persuasiveness with which the doctor talks about their effectiveness. Compared to no treatment, and maybe even compared to some other forms of placebo, acupuncture can be quite effective as a pain reliever. Reviews of the scientific literature indicate that it may be effective in treating migraines and some other types of headaches, as well as neck pain. On the other hand, acupuncture has not been shown to be effective for reducing shoulder girdle pain, elbow pain, or acute low back pain (lumbago).

In 2013, the journal Anesthesia & Analgesia published an article by David Colquhoun and Stephen Novell titled “Acupuncture – Theatricalized Placebo.” Why theatrical? An acupuncture session is much more complicated than taking a regular white pill. It is a lengthy procedure done by an experienced, usually empathic practitioner, following a strict set of rules. He devotes a great deal of time to the patient, expresses interest in his problems, and provides a sense of comfort. The seriousness of these procedures convinces the patient that something special, helpful is being done to him. And this reinforces the placebo effect.

Arguments FOR. Acupuncture is part of an unusual culture

Not everything we do is for the health of the body. Some things we do simply because they are interesting, unusual and make us feel that we are in the shoes of a person from another culture or epoch. And acupuncture, as an ancient ritualized practice, is certainly of cultural and historical value. In 2010, it was included in the list of Intangible Cultural Heritage of Humanity by UNESCO. By attending acupuncture sessions, you support cultural diversity. Isn’t that a form of leisure and charity?

Many people like it.

A passion for acupuncture can give you a topic to talk about and even help you make friends. Millions of people use this branch of alternative medicine, and many books and articles have been written about it. There are groups of acupuncture enthusiasts on social media. Do you want to talk about your health with sensitive and attentive interlocutors? Join this rather large hangout. According to a 1998 study published in JAMA (Journal of the American Medical Association), dissatisfaction with conventional medicine is not a factor in pushing people to pursue alternative medicine in the United States. The most significant factors in the attraction to alternative medicine were found to be a holistic philosophical view of health (“health of body, mind, and spirit are interconnected”), having a transformative experience, some event that changed one’s lifestyle and view of the world, and belonging to the “creative class.

Works on tadpoles

The original Chinese concepts of acupuncture assumed the existence of “meridians” through which the vital energy Qi circulates. Modern studies of human anatomy have found nothing special in these places. One of the possible hypotheses was that the signal of influence spreads directly through the skin cells. This idea cannot be considered completely unscientific: in some organisms, skin cells are excitable and can transmit electrical signals like nerve cells. Mechanical action on a tadpole’s skin causes the generation of an electrical impulse, which spreads through all the skin cells and is transmitted to the nervous system. If we were tadpoles, we would easily understand why skin irritation triggers our physiological and behavioral responses. But we are not tadpoles. Human skin cells are not electrically excitable and cannot conduct a signal in this way.

Arguments against. Possible side effects.

According to a review published in the journal Pain in 2011, between 2000 and 2009, 95 people were seriously affected by acupuncture – five of whom died. Most of the victims lived in Asia, but some incidents occurred in the U.S., Britain and other European countries. A rare but most dangerous complication of acupuncture is pneumothorax, a puncture of the pleural cavity of the lung. Pneumothorax leads to respiratory distress and acute lack of oxygen, the person needs urgent medical attention. The most common problem is contracting infectious diseases. A recent review by scientists at the University of São Paulo in Brazil described 295 cases of acupuncture-related infections. Most were caused by the bacterium Mycobacterium abscessus, which is often found in dirty water and, when ingested, can cause skin lesions, lung damage, and festering wounds. Infections can spread, for example, because the therapist uses non-sterile needles or insufficiently clean towels. Considering that there are millions of acupuncture sessions a year around the world, it’s safe to say that complications are very rare. But that does not mean they are impossible.

You support unscientific concepts.

There is a swarm of superstitions, myths and misconceptions around acupuncture, like stories about meridians, life energy, etc.? That’s fine if you treat it with a certain amount of irony. But some people seriously start to believe in magic points on the body, build strange unscientific theories around them, get hung up on them. And when these theories are not taken seriously by the scientific community, they turn away from science and become adherents of esoteric, pseudoscientific teachings. Will you be able, having plunged into this culture, to stop in time and not pass on to more dangerous forms of alternative medicine like “cleansing from dross” or eating of dubious oriental roots with unknown effect?

Chances are, the disease would have gone away just as it did.

Those varieties of pain syndrome for which acupuncture helps are usually not very serious. This means that they (like many diseases) can go away on their own, even without any placebo effect, just in the normal course of the body’s recovery. Completely independent of acupuncture. If you are seriously ill, however, it is worth seeing a real doctor immediately to get the most effective medicine. If after that you have the time and money to go to an acupuncture session – that’s okay. But don’t try to treat serious illnesses with acupuncture alone. You could waste precious time and pay for your health or even your life.

What is your evidence?

Whether acupuncture boasts any mechanisms of action other than the placebo effect is still unclear. Of course, there are many studies of this procedure, but they are all empirical data on whether it helps or not. If we talk only about pain relief, a number of studies have accumulated that demonstrate the effectiveness of the method. However, some of them show that acupuncture works just as well even if the needles are injected not into special points approved by Chinese medicine, but into any randomly chosen area of the body – to speak of the placebo effect. Some work has shown that acupuncture can be effective for some forms of allergy. But even here everything is ambiguous: these results, as a rule, cannot be reproduced in other studies. As for serious diseases, such as cancer, there is simply no conclusive evidence of the effectiveness of acupuncture to combat them.

Conclusions

So does acupuncture work? And how dangerous is it? In most cases, acupuncture is safe. The atmosphere of receiving it in the style of ancient Chinese medicine is an interesting experience. For a number of pain syndromes, acupuncture is more effective than no treatment at all. Apparently, its effect comes down to the placebo effect. There are neither theoretical assumptions nor experimental data that justify the use of acupuncture to treat serious and life-threatening diseases.

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