Wednesday, August 22, 2012

Lying About Acupuncture

Awhile back I posted an article over on my author web site about the documentary that inspired the film The Men Who Stare at Goats. Both the fictionalized film and the documentary deal with attempts by the military to make use of paranormal phenomena such as remote viewing and psychic influence. While these programs have for the most part ended (or, if you happen to be conspiracy-minded, classified beyond the reach of the public) one area in which this sort of thing is still ongoing is in the use of alternative medicine such as acupuncture. Slate published an article on the use of acupuncture by military doctors this week, but unfortunately what surprised me the most about it was not anything about the techniques themselves but rather the author's dishonesty.

Acupuncture is based on a mythical, nebulous energy called qi that has never been detected, even though scientific instruments are capable of measuring quantum energies at the subatomic level. It is said to flow through hypothetical meridians and to be altered by sticking needles into hypothetical acupuncture points. Originally, there were 360 acupuncture points, corresponding to the days of the year, which is not surprising since the idea grew out of astrology. Now so many acupoints have been described that one wag suggested there was no place left on the skin that wasn’t an acupuncture point in someone’s system.

Many proponents of acupuncture reject the esoteric explanations but believe acupuncture has a real physiological effect. Various mechanisms have been proposed, but none is convincing. Needling can release pain-killing endorphins in the brain, but that’s a nonspecific effect: Placebo pills do the same thing, and just throwing a stick for a dog releases endorphins in the dog’s brain.

We don’t need to know how it works to know if it works. Acupuncture has been tested repeatedly and found wanting. Studies have shown that it doesn’t matter where you stick the needles, and it doesn’t matter whether you pierce the skin. Stimulating intact skin with toothpicks or electricity works just as well. The crucial factor seems to be whether patients believe they are getting acupuncture.

In the first paragraph, it needs to be pointed out that at least one form of Qi has been detected by Chinese researchers as far back as the mid-1990's. I commented on one of those studies back in 2006. In China Qigong (including acupuncture) is a regular part of medical practice, so it gets a lot of attention from researchers and publication space in journals. While it's not unreasonable to question some of the findings of those studies, to state that Qi has never been detected is a massive oversimplification. There's no huge body of work by Western scientists showing similar results, so one could perhaps make a case that the Chinese data needs to be replicated by American researchers before being taken seriously - but given the bias against experiments on anything considered "paranormal" in American academia, who's going to risk their career by performing them? Also, it's not like the Chinese studies are inherently unsophisticated or poorly designed, or for that matter published without peer review.

The third quoted paragraph, though, is the worst because it's an outright lie. A 2011 meta-analysis of the large body of acupuncture research from 1997-2007 clearly shows that according to many solid, controlled clinical trials it does make a difference whether or not the needles puncture the skin. This particular study was not hard to find, either - it's cited in the third paragraph of the acupuncture article on Wikipedia! Apparently reading past the second paragraph of that article was too much to ask of this professional journalist. I don't even get paid for my writing here on Augoeides, but when I cite a Wikipedia article at least I read the whole damn thing. Maybe that means I'm in the wrong business, since I could apparently make more money doing a lot less.

Now it is true that this same study also shows that there seems to be little difference in efficacy between inserting needles at the "official" acupuncture points versus other points on the skin in the same general area, so significant questions do remain regarding the acupuncture system as a whole. This is probably also the reason that the various acupuncture systems disagree with each other about specific points. However, the author's breezy dismissal of what is in fact a complex set of findings strikes me as fundamentally dishonest and betrays a deep bias. There's a big difference between being a genuine skeptic and an unthinking naysayer.

Whether or not the military should be using acupuncture given its mixed experimental track record is a question on which I can see reasonable people disagreeing, but any discussion of the subject should at least include facts rather than half-truths and outright misrepresentations.

UPDATE: A little more digging on Harriet Hall, the author of this piece, turned up an association with the Skeptical Inquirer and James Randi's CSICOP. Color me completely unsurprised, given its tone. This isn't cluelessness as I originally assumed, but rather a deliberate polemic. You know, like when these same folks explain with a straight face that paranormal reality shows will invariably lead to women being burned at the stake. And they call us deluded!

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Stefano Marcelli said...

Dear Scott Stenwick,
possibly I am at the life stage I need some paranormal hints :-).
Even though this can sounds quite presumptuous, I am the pioneer who first applied scientific method to research in acupuncture. Thus, after having painstakingly sifted the Acupuncture Meridian System, I conquered the right to state that it is too complex and logically ordered to be a false construction.
Please, before visiting the site where are collected all my scientific observations on the acupuncture meridians, take a look at what I think the Acupuncture Meridian System really is:
Best regards,
Dr. Stefano Marcelli

Scott Stenwick said...

As I see it the main problem with a morphogenic analysis of the acupuncture points is that there are other possible explanations for the similarities that need to be ruled out before any firm conclusions can be drawn.

(1) Points that are found in specific places in animals but not in humans don't really prove anything because the Taoists were big on generalizing from human to animal. You see this at work in unrelated areas such as Chinese Kung Fu styles, for example, in which animal movements are mimicked.

(2) Similarity of meridian shapes to organ shapes could simply be the result of anatomical dissection: "the organ is shaped like this, so the meridian should look this way too." Then taking that as a base, adjust the exact geometry until the points seem to work. That's not particularly mysterious either.

The increased heat at acupressure sites is possibly an interesting finding, but you need a larger sample size and a better control condition before you can say anything definitive. Keep in mind that I'm a 5-element Qigong practitioner myself and I don't think the meridian system is artificially constructed either. I also am quite familiar with Sheldrake's work on morphogenesis and open to applying those ideas to the meridian system if you have the data to back it up.

My current working hypothesis is that the structure of the acupuncture meridians are related to the lymphatic vascular system. We know that the lymphatic system mediates the immune system response, and that lymphatic fluid is pushed through the body by movement rather than a pump such as the heart. Thus, there's a link between moving Qigong sets, meditation (the relaxation response), and the concept of "stagnant Qi" - that is, lymphatic fluid that isn't moving through the body efficiently.

So according to that idea, acupuncture works by penetrating the lymphatic channel just below the skin in proximity to a significant vessel or channel. This, then, provokes a mild inflammation/immune system response at the point which releases white blood cells and so forth to deal with toxins, illness, and so forth. Note that the meridians do basically follow both the lymphatic vessels and the nervous system

I think that a lymphatic model could explain your heat findings just as well as any sort of morpogenic model. That doesn't mean either one is right or wrong, but it seems to me that more experiments need to be done to rule out one or the other. I probably would set out to disprove my lymphatic model first, because it relies more on established biological principles and less on more speculative ones like morphogenics.

If you ever do conduct such research, I would be interesting in hearing what your findings are. Because if the lymphatic model is wrong, I'll happily move on to something else that fits the data more closely.