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1. Acupuncture is a pre-scientific superstition

Acupuncture is based upon the Eastern philosophy of chi (also spelled qi), which is the Chinese term for the supposed life force or vital energy that animates living things. In Traditional Chinese Medicine (TCM) chi flows through pathways in the body known as meridians. Illness results from the flow of chi through the meridians being blocked, or by the two types of chi (yin and yang) being out of balance. Acupuncture is the practice of placing thin needles at acupuncture points, which are said to coincide with points at which meridians cross, to improve the flow and restore the balance of chi.

There is no more reason to believe in the reality of chi than there is in the four humors, or in the effectiveness of acupuncture than the effectiveness of bloodletting.


2. Acupuncture lacks a plausible mechanism

Centuries of advancement in our understanding of biology has made the notion of life energy unnecessary. Further, no one has been able to detect life energy or formulate a scientifically coherent theory as to what life energy is, where it comes from, and how it interacts with matter or other forms of energy. Within science, the vitalists lost the debate over a century ago. Without chi, there is no underlying basis for acupuncture as a medical intervention.

Recent attention given to acupuncture has attempted to bring it into the scientific fold by hypothesizing physical mechanisms for its alleged effects. For example, some proponents argue that the needles may stimulate the release of pain-killing natural chemicals, relax tense muscles, or inhibit the conduction of pain through counter-irritation.

These potential mechanisms, while more plausible than the non-existent chi, remain speculative. Further, they would only explain the very non-specific effect of acupuncture causing a temporary mild reduction in pain (no better than rubbing your elbow after accidentally banging it against something hard). Such mechanisms could not account for any of the medical claims made for acupuncture, or the alleged existence of acupuncture points.

Further, it is misleading to say that such mechanisms could explain “acupuncture.” Acupuncture is the needling of acupuncture points to affect the flow and balance of chi. Using needles to mechanically produce a temporary local counter-irritation effect is not acupuncture – even though it may be an incidental consequence of this practice and may have contributed to its perceived effectiveness.


3. Claims for efficacy are often based upon a bait-and-switch deception

The most common example of the “bait-and-switch” for acupuncture are studies that examined the effects on pain of electrical stimulation through acupuncture needles. This is not acupuncture – it is transcutaneous electrical stimulation (TENS), which is an accepted treatment for chronic pain, masquerading as acupuncture.

Electrical stimulation is no more acupuncture than if morphine were injected through a hollow acupuncture needle and then claimed that any resulting pain relief was due to “acupuncture.”

Further, during a typical acupuncture treatment there are many other incidental effects that may occur. The atmosphere is often relaxing, and practitioners typically will palpate the “acupuncture points” prior to inserting the needles, for example. Practitioners also provide their kind attention, which has a positive psychological therapeutic value. There are therefore many nonspecific subjective effects that could lead to clients feeling better, making the actual insertion of needles an unnecessary component.

Reports of acupuncture anaesthesia are also misleading. Independent investigation shows that patients having surgery under anaesthesia (dramatic reports of which are largely credited with acupuncture’s popularity in the West) reveal that patients were receiving morphine in the IV fluid. Other reports indicate that patient were experiencing great pain, but were simply instructed to remain quiet by the surgeon (a product of Eastern culture). There are no verified reports of acupuncture serving as effective anesthesia during surgery.

4. Clinical trials show that acupuncture does not work

It is important to evaluate the literature as a whole to see what pattern emerges. The pattern that does emerge is most consistent with a null effect – that acupuncture does not work.

Controlled clinical trials of actual acupuncture (uncontrolled trials should only be considered preliminary and are never definitive) typically have three arms: a control group with no intervention or standard treatment, a sham-acupuncture group (needles are placed but in the “wrong” locations or not deep enough), and a real acupuncture group. Most of such trials, for any intervention including pain, nausea, addiction, and others, show no difference between the sham-acupuncture group and the true acupuncture group. They typically do show improved outcome in both acupuncture groups over the no-intervention group, but this is typical of all clinical trials and is clearly due to placebo-type effects. Such comparisons should be considered unblinded because patients knew whether they were getting acupuncture (sham or real).

The lack of any advantage of real- over sham-acupuncture means that it does not matter where the needles are placed. This is completely consistent with the hypothesis that any perceived benefits from acupuncture are non-specific effects from the process of getting the treatment, and not due to any alleged specific effects of acupuncture. In other words, there is no evidence that acupuncture is manipulating chi or anything else, that the meridians have any basis in reality, or that the specific process of acupuncture makes any difference.

More recent trials have attempted to improve the blinded control of such trials by using acupuncture needles that are contained in an opaque sheath. The acupuncturist depresses a plunger, and neither they nor the patient knows if the needle is actually inserted. The pressure from the sheath itself would conceal any sensation from the needle going in. So far, such studies show no difference between those who received needle insertion and those who did not – supporting the conclusion that acupuncture has no detectable specific health effect.

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study the smaller the effect, and the best-controlled trials are negative. This pattern is highly predictive of a null-effect – that there is no actual effect from acupuncture.

Chernobyl Prize posted:

I'm hoping for great things from this thread. I want to hear about acupuncture/pressure, crystals, homeopathy, and chiropractic medicine. I've never heard of marijuana being called alternative medicine, when discussed for health reasons it's always medicinal marijuana as if everyone knows it's not bullshit.

A big flaming stink posted:

So...is acupuncture shown to have evidence-based medical benefits? Or shown not to? Or is it inconclusive either way? it's hard to tell what with the bickering

SBM posted:

Taken as a whole, the pattern of the acupuncture literature follows one with which scientists are very familiar: the more tightly controlled the study the smaller the effect, and the best-controlled trials are negative. This pattern is highly predictive of a null-effect – that there is no actual effect from acupuncture.

Cheekio posted:

I agree with this, and I think the problem with the discussion about Herbal Medicine is I don't know any way to accurately pin down the terminology to be clearly right or wrong. Echenecea apparently isn't more effective than placebos, but willow bark certainly is.

Kiwi Ghost Chips posted:

No, because the FD&C definition of drug includes


Any medical claims at all means it's regulated under one class or another.

Kiwi Ghost Chips posted:

Dietary supplements don't need approval because the fact that they're limited to nutrients and plant-derived substances is supposed to make them safer (lol). Manufacturers still have to follow manufacturing standards and report severe side effects, and the FDA can take action if there's evidence that one is dangerous to more than just your wallet.

Homeopathy has special exemptions just for their "medicine."

Melthir posted:

Does anyone have anything that shows why you think chiropractors are horeshit. Because I tell you what, I feel like a million bucks after I get my back adjusted. If it is poo poo I would like to know why and what about getting my back adjusted is feeling good.

snorch posted:

duz posted:

And also the placebo effect can make medication less effective if you don't have confidence in it. The human body is weird.

SurgicalOntologist posted:

I'm a psychologist who studies movement, posture, and coordination in general. Just attended a talk from a biomechanist about fascia, the elastic connective tissue that surrounds muscles. Medicine hasn't paid much attention to it but it's becoming clear that it's pretty important to a lot of things.

Anyways, posting here because she thinks she figured out how acupuncture works and I think she's right (this wasn't the focus of her talk, it came up in conversation afterward). She looked at fascia under a microscope during acupuncture. What happens is when the needle is inserted, the fascia strands stick to it and wrap tightly around it. Then the needle is twisted and those fascia strands wrap more tightly and ultimately give it a nice stretch. So it seems it's a similar benefit as foam rolling or deep massage but more precise and targeted.

Doesn't explain all the purported benefits of acupuncture, of course, but it's very interesting. I might even have to try it out for my back pain--foam rolling eliminates it for about an hour, I wonder what acupuncture would do.

Also I love Ben Goldacre. I play some of his videos to my students when I teach research methods.

CommieGIR posted:

This is called 'special pleading'

Outside of affects on actual pain, the needling is more than likely not treating the underlying cause.

Might as well just taken pain killers.

Its still scientifically bunk.

Tim Raines IRL posted:

do you take this same view about every single drug that lands on the market with lots of "pharmacokinetics unknown, more study needed" buzz around it? If not, why the double standard?

Mr. Wiggles posted:

You can't find any masseuse anywhere that will pop your back and other joints, though, so you've got to go with the place that makes you feel good. Until the crazy Uzbek massage parlour finally moves into town, it's the chiropractor for me!

Alterian posted:

One thing I've been wondering is if zinc lozenges actually work to shorten colds. I thought there was studies done showing they're effective, but when I went to buy some, they're labeled as homeopathic. They do contain actual zinc in them, not some weird dilution. I thought the mechanism behind it was the zinc inhibits the cold virus from multiplying so your body can get the advantage on them. Do these really work or is it more quackery?

IAMNOTADOCTOR posted:

Unfounded in reality, most if not all large pharmaceutical companies started with compounds derived from nature and this remains to day one of the most important sources of new drug patents and profit. Moreover, "big pharma" has some but mostly insignificant influence on the standard regulatory process. There are enough issues with pharmaceutical companies, making them up is not needed at all.

Tim Raines IRL posted:

It doesn't help that modern farming techniques may be depleting magnesium among other things.
http://www.ncbi.nlm.nih.gov/pubmed/19013359
http://www.scientificamerican.com/article/soil-depletion-and-nutrition-loss/

That said, I'm skeptical that it's a great idea to take an assload of supplemental magnesium on a constant basis. My own experience (along with several other anecdotes I've read) was that after doing so for a period of time and then stopping abruptly, I had specific, unpleasant and fairly protracted muscle spasms which started 2-3 days after cessation, were relieved by taking more magnesium, and persisted for a period of about 3 weeks. Seems like drug withdrawal to me, which doesn't surprise me too much since magnesium appears to interact with NMDA receptors significantly.

Hodgepodge posted:

Unless, like me, you take it for spasms and other muscle-related effects of depletion and over-activation of the NMDA receptions.

It does sound like your body adapted to a larger magnesium intake. I'm not sure if that is a bad thing though, it wasn't causing problems in and of itself, and I'm hesitant to agree offhand that "my body adapted to using less of an essential nutrient again" is a good thing. Your body needs a fair amount of it to run, and will literally take it from your bones if it needs more (http://en.wikipedia.org/wiki/Hypomagnesemia#Homeostasis). This is not an expert opinion.