Acupuncture is one of the oldest, most popular, and most-studied of all alternative therapies. It has thus ‘stood the test of time’ and is beyond doubt or reproach… or at least, this is what its many enthusiasts tell us. However, as so often in the realm of so-called alternative medicine (SCAM), things are not so simple.
The complexity starts with the fact that there is not one but many different forms of acupuncture. Acupuncture points can allegedly be ‘stimulated’ by sticking needles into the skin of a patient, by implanting tiny devices, by applying heat, electrical currents, ultrasound, pressure, bee-stings, injections, or light. Then there is body acupuncture, ear acupuncture, scalp acupuncture, and even tongue acupuncture.
Some therapists employ the traditional Chinese approach, while so-called ‘Western’ acupuncturists proudly claim to adhere to the principles of conventional medicine. Both camps have in common that they are based on mere hypotheses trying to explain that acupuncture might work. According to the traditional view, acupuncture is effective for virtually every condition affecting mankind, while ‘Western’ acupuncturists claim it works mostly for alleviating chronic pain. But where is the evidence for these claims?
Medline, the largest databank for medical papers currently lists more that 40,000 papers related to acupuncture. It is therefore not difficult to find some evidence for even the most outlandish claims acupuncturists tend to make. Yet, the question is, how reliable is this evidence? When trying to answer it, critical thinking is essential, and numerous caveats must be considered.
The majority of all acupuncture studies originate from China. Several investigations have disclosed that, for a range of reasons, we should take these trials with a pinch of salt: they invariably report positive results, their results are often fabricated, and they are frequently generated by illegal paper-mills. In addition, many acupuncture studies draw unwarrantedly positive conclusions on the basis of dodgy data. The combined effect of these phenomena is that the body of evidence supporting acupuncture is less than reliable.
So, how can we decide whether acupuncture works or not? Some might argue that one just needs to try it and see for oneself. However, I would caution that this is a bad idea. Acupuncture has many features that make it an ideal placebo: it is exotic, invasive, slightly painful, costs money, administered by an empathetic therapist, etc. Any symptomatic improvement after acupuncture might therefore be due to context effects and could be entirely unrelated to the therapy per se.
The best way to make sense of this convoluted evidence probably consists of conducting what experts call a systematic review. This involves firstly to locate all the available studies that exist for any given research question, and secondly to assess them critically according to their scientific rigour.
During recent years, numerous systematic reviews of acupuncture as a treatment for dozens of different conditions have emerged. Unfortunately, many are by Chinese enthusiasts and overtly biased. Those that are most transparently independent and methodologically sound are those produced by the Cochrane Collaboration.
My overview of the 54 systematic reviews published by this organisation, failed to show that acupuncture is effective for treating any condition; positive evidence emerged only for the prevention of migraines and tension type headaches. More recently, a US team used a different approach for an overall assessment of the effectiveness of acupuncture. If anything, their conclusions were even less favourable:
Despite acupuncture having been the subject of hundreds of randomized clinical trials and systematic reviews for dozens of adult health conditions, there were few conclusions that had greater than low certainty of evidence.
Acupuncture is often promoted as being free of risks. Yet, mild to moderate side effects of acupuncture occur in about 10% of all patients. Much more serious complications of acupuncture are also on record. Acupuncture needles can, for instance, injure vital organs like the lungs or the heart, and they can introduce infections into the body, like hepatitis. A recent example is one of the star players of England’s women’s football team, Ellen White, who’s recent decision to retire was partly due to an incident in which an acupuncturist punctured her lung.
About 100 fatalities after acupuncture have been reported in the medical literature—a figure which, due to the lack of a monitoring system, most likely discloses just the tip of the iceberg.
Given that, for most conditions, there is no reliable evidence that acupuncture works, and that it has been associated with significant harm, its risks usually outweigh its benefits. Therefore, my advice for consumers is to think twice before paying considerable amounts of money for what seems little more than a theatrical placebo.
