Lymphatic Vessels Link Brain and Body

Back when I was in college around 1990 one of the hot areas of interdisciplinary study was psychoneuroimmunology, a field built around the experimental observation that cognitive states could affect the function of the immune system. Researchers hoped that such a connection could provide an explanation for the placebo effect, the effectiveness of alternative healing modalities such as acupuncture, and impaired immune system function in depressed patients. It was also thought that it might be relevant as an explanation for the "relaxation response" provoked by meditation, which appears to have anti-inflammatory properties.

The base hypothesis was a logical one, but the mechanism behind it proved incredibly stubborn. Especially in the case of the placebo effect, it's not that anyone doubts something real is going on. It has to be controlled for in every medical drug trial, even though it's poorly understood. Also, last year researchers studying acupuncture may have discovered a chemical pathway involving interleukin-10, an anti-inflammatory compound produced by the immune system, that seems to be activated by acupuncture treatment.

In my article, I offered up the hypothesis that this interleukin-10 pathway could work in conjunction with the lymphatic system to produce the results reported for acupuncture treatment. A chart of the acupuncture meridians follows the lymphatic system fairly precisely, and a needle pentrating a lymphatic vessel will promote an immune response. So the needle would promote the production of interleukin-10 at the point of contact, and the lymphatic system would move the substance some distance from it. This is a straightforward chemical model that involves no mysterious energies, while at the same time explaining the effectiveness of exercises such as Qigong sets that promote the movement of lymphatic fluid.

Neuroscientists have now identified that the network of lymphatic vessels connected with the brain is more extensive than previously thought, which not only supports some of my contentions about acupuncture but which may also finally provide the mechanism that psychoneuroimmunologists have been seeking for nearly thirty years. It could explain the placabo effect and many other findings that relate subjective state of mind to immune system function. The newly discovered vessels are shown in green in the image on the right.

Acupuncture Skeptics Losing Ground

It's been awhile since I've seen an all-out skeptical tirade against acupuncture. Back in 2012 I posted a study that found clear evidence of its effectiveness in response to an article attacking the practice. Since then, I've put forth the idea that acupuncture may work by affecting elements of the lymphatic system, and according to a new study published in the journal Molecular Neurobiology I wasn't that far off. Researchers tracked the precise biochemical changes that accompany acupuncture treatment, and have identified what could be a totally scientifically verifiable mechanism.

The secret is in the biochemistry. M2 macrophages are an important source of IL-10 (interleukin-10), an anti-inflammatory cytokine that plays an important role in immune responses. Cytokines are proteins released by cells that regulate reactions between cells. Manual acupuncture successfully downregulates M1 macrophages and upregulates M2 macrophages thereby promoting the release of greater IL-10 concentrations. As a result of IL-10 release, pain and inflammation significantly reduce.

This study measured responses in muscle tissues and confirmed that M1 to M2 macrophage phenotype switching is triggered by acupuncture stimulation. Acupuncture literally flips a switch wherein initial inflammatory responses are reduced and the secondary healing responses are promoted. M1 macrophage downregulation and M2 macrophage upregulation triggered by acupuncture was positively associated with reductions in muscle pain and inflammation.

The researchers tested the biochemical process by adding an IL-10 blocking agent in the laboratory experiment. When IL-10 was chemically blocked, acupuncture did not reduce pain and swelling. However, when no blocking agent was applied, acupuncture successfully reduced both pain and swelling. The M2 macrophage upregulation by manual acupuncture successfully created a greater source of IL-10. The researchers note, “These findings provide new evidence that MA (manual acupuncture) produces a phenotypic switch in macrophages and increases IL-10 concentrations in muscle to reduce pain and inflammation.”

Victims of Discount Acupuncture?

Skeptics like to argue that acupuncture doesn't do anything at all, even though the most recent studies show it to be more effective than sham treatments in which the needles are placed improperly. But here's something those studies never observed - spontaneous human combustion! After a mysterious death in Louisiana attributed to this supposed phenomenon, some acupuncturists are warning the public that being treated at discount acupuncture clinics can make them explode. I suppose that's a useful safety tip, you know, if you believe such a thing is even possible.

Some local medical professionals have proposed a controversial theory. Based on reports that Thomas has undergone acupuncture treatments for sciatica several times in the weeks preceding his untimely fulmination, a group of local experts are speaking out. They are warning the community to beware discount acupuncture clinics.

“We aren’t saying that every incidence of spontaneous human combustion is linked to the incorrect placement of acupuncture needles,” Kuang Zhu LAC, Chief of Pragmatic Acupuncture in the Health and Wellness division of Vic’s Day Spa and Pet Grooming Center, explained during a recent press conference. “But in some cases, there is a relationship that is hard to explain otherwise.”

Now what I want to know is in all the studies that have been done trying to differentiate between sham acupuncture and the real thing, what happened to all those exploding subjects in the control group? Because the whole point of sham acupuncture is that it deliberately is done incorrectly with the needles inserted at different points than those specified but in the same general area of the body. Oh, that's right, there aren't any! So it seems to me that this is a transparent attempt to drum up business for the non-discount clinics, which by definition charge more.

Yes, Acupuncture Does Work

A little over two weeks ago I responded to an article by skeptic Harriet Hall that misrepresented the current state of research on the effectiveness of acupuncture to what I considered an appalling degree. As it turns out, Hall picked a bad time to launch her tirade - because the latest meta-analysis of acupuncture research, published two days ago in the Archives of Internal Medicine, conclusively shows that acupuncture does in fact work for chronic pain. Notably, this latest study also found a clear difference between traditional acupuncture in which needles are inserted at specific, defined points versus so-called "sham acupuncture," in which needles are inserted at random points in the same general area.

After re-analyzing data from 29 high-quality clinical trials dating back to the 1990s, researchers have concluded that the pain relief derived from acupuncture is partly real, in that it can't be ascribed entirely to the placebo effect.

The trials, which included roughly 18,000 people with chronic pain stemming from arthritis, headaches, or back and neck problems, all compared genuine acupuncture with one of two alternatives: treatment as usual, or "sham" acupuncture -- a counterfeit (i.e. placebo) version of the treatment in which needles are inserted unsystematically.

Pain relief of 50% or more on a 100-point scale -- pain that drops from a 60 to a 30, say -- is a commonly used standard of effectiveness in pain research. By this measure, the study found, the effectiveness rates for real acupunture, sham acupuncture, and treatment as usual are 50%, 43%, and 30%, respectively.

While an argument can be made that some of the benefits of acupuncture are due to the placebo effect - and, as in most medical trials, some of them almost certainly are - a difference of seven percentage points is nonetheless quite significant. Some clinical antidepressants, for example, show less improvement than this versus placebo and nonetheless are fully accepted by the scientific establishment. The problem skeptics have with acupuncture seems to be that nobody has figured out exactly how it works, but it should also be noted that biochemists have yet to work out the exact mechanism behind many antidepressant drugs as well. Either said skeptics just don't have their facts straight, or they're deliberately confusing them to push what I would have to call an anti-science agenda. The whole point of the scientific method is that you don't get to pick and choose only those studies that confirm your personal biases.

Those of us who think that technology may finally be getting to the point where we can empirically verify magical results have to be ready for this. Being a real skeptic means withholding judgment until the data is in and following it wherever it leads, whether it confirms your beliefs or not. Skeptics like Hall, though, seem to think that it means slapping down any scientific result that looks weird, no matter how well the experiment that obtained it was constructed and performed.

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.