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Acupuncture: Getting the point [Respectful Insolence]

Thursday, November 17, 2016 5:57
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I’ve frequently written about what I like to refer to as “quackademic medicine,” defined as the infiltration of outright quackery into medical academia, particularly medical schools and academic medical centers. There’s no doubt that it’s a significant problem as hallowed institutions like Memorial Sloan-Kettering Cancer Center embrace nonsense, pseudoscience, and quackery in the name of “integrative medicine.” It goes far beyond MSKCC, however, with Dana-Farber and other elite institutions having apparently bought into the need to study prescientific vitalistic quackery.

One area that’s steeped in woo and has been for a long time is exercise and fitness. I was reminded of this when a reader sent me a link to an article in the November issue of EXPERIENCE L!FE Magazine by Selene Yeager entitled Acupuncture: Getting to the Point. I groaned at the cliched title, but was willing to give Yeager a pass because most headlines are chosen by the editor, not the author. What I was not willing to give her a pass on was the credulous take on acupuncture delivered. In fact, the credulous take was seen in two articles, because the first article was accompanied by an article about acupuncture research by Yeager, Making the acupuncture connection, which inadvertently shows how deep acupuncture has infiltrated medical academia.

The first article, as most such articles do, begins not with evidence but with an anecdote, this time about a man named John Pacharis, who crashed his off-road motorcycle, tearing his ACL, MCL, and PCL — three of the four major ligaments in his knee. Obviously, his knee was messed up bad (my medical terminology), and he needed surgery. He took too many opioids by his account and when he learned he needed another operation:

He began searching online for ideas about how to better manage his recovery and came across a support group where someone suggested acupuncture. “I was very skeptical but figured I might as well try it,” recalls Pacharis. “The first thing the acupuncturist did was put needles in my hands to calm me down and lower my heart rate. I felt an immediate, amazing flow of euphoria. It was like Dilaudid — but obviously so much better for me.”

Pacharis received weekly acupuncture treatments for two months, both to keep swelling under control and to manage pain with fewer drugs. He still gets treated on occasion, and says he’d do more if it were covered by his insurance.

“I don’t know how it works,” he says. “But it definitely works.”

Of course, as I’ve discussed before, there is no good scientific evidence that acupuncture has a detectable effect on chronic knee pain above and beyond placebo, a systematic review by the NCCIH notwithstanding. Basically, acupuncture is a theatrical placebo, all small risks and no real benefit. You’d never realize it from this article, though, which launches right into a discussion of emergency acupuncture, complete with the favored narrative of acupuncturists working side-by-side with real doctors:

“The current opioid epidemic has opened the door for safer, more natural ways to reduce pain,” says acupuncturist Adam Reinstein, LAc. He was hired in 2013 to work in the emergency room at Abbott Northwestern Hospital in Minneapolis as part of the hospital’s campaign to integrate Eastern techniques with a Western medical approach. He’s the first acupuncturist on an ER hospital staff in the United States.

During one shift, he might treat a car-accident victim and someone suffering complications from chemotherapy with the same basic approach. “We look at acupuncture as the first level of pain and anxiety relief,” he says. “Pain, anxiety, and nausea are the big three I treat most in this setting. In many cases, I can help patients start to feel better in the first two to five minutes.”

I can tell you that if I’m ever in a car wreck and land in an emergency room, if I see an acupuncturist offering to stick needles into me the reaction will not be a pleasant one. Of course, acupuncturists like to claim that there’s value to using it in the emergency room, but whenever I look at actual attempts to study its use there, I am inevitably underwhelmed by the results. Yeager notes that there has been a study of the results of emergency acupuncture at Abbot Northwestern Hospital that was very promising. So I looked it up, my intention being to do my usual deconstruction. Basically, it was an observational, retrospective study. No randomization. No blinding. No prospective enrollment of patients. In other words, for a subjective measure like pain it was pretty much a worthless study, and I saw little reason to delve more deeply.

This leads to the propaganda. Yeager first notes that the Kansas Chiefs hired the NFL’s first acupuncturist 23 years ago, that the US Air Force is using “battlefield acupuncture,” and that the VA in Boston is offering acupuncture. Of course, I’v discussed how ridiculous battlefield acupuncture is on many occasions, including the lack of evidence for its efficacy, and just how deeply pure quackery has infiltrated the military, as well as the VA. Unfortunately, Yeager buys completely into the myth of acupuncture:

Though pain relief is still the primary reason many Westerners seek acupuncture, more have discovered what people in China, where acupuncture is part of routine medical care, have long understood: Acupuncture can offer relief from a vast array of health problems, including digestive issues; stress, anxiety, and depression; respiratory disorders, such as asthma and allergies; hormone-related issues like infertility, PMS, and menopausal symptoms; and more. Read on to explore whether it might be right for you.

Of course, what Yeager seems not to realize is that more and more Chinese seek real medicine and reject traditional Chinese medicine (TCM). Indeed, what is considered “TCM” today is in actuality a retconning of several lines of Chinese folk medicine into a seemingly unified whole conducted under the rule of Chairman Mao Zedong. Acupuncture as we know it didn’t really exist until maybe 100 years ago, claims of its antiquity dating back thousands of years notwithstanding. The earliest Chinese texts don’t mention acupuncture, for one thing. For another thing, European surgeons who observed acupuncture and TCM as they were practiced in the hinterlands of China 100 years ago were horrified. Indeed, Mao himself preferred “Western medicine” and eschewed TCM. I’ll just quote one passage from the memoir of a Scottish surgeon named Dugald Christie, who served as a missionary doctor in northeastern China from 1883 to 1913:

Chinese doctors own that they know nothing at all of surgery. They cannot tie an artery, amputate a finger or perform the simplest operation. The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood vessels and important organs, and immediate death has sometimes resulted. A little child was carried to the dispensary presenting a pitiable spectacle. The doctor had told the parents that there was an excess of fire in its body, to let out which he must use cold needles, so he had pierced the abdomen deeply in several places. The poor little sufferer died shortly afterwards. For cholera the needling is in the arms. For some children’s diseases, especially convulsions, the needles are inserted under the nails. For eye diseases they are often driven into the back between the shoulders to a depth of several inches. Patients have come to us with large surfaces on their backs sloughing by reason of excessive treatment of this kind with instruments none too clean.

Acupuncture is believed to have developed from the Chinese version of bloodletting, very much like the “Western” version of bloodletting. This is the “ancient wisdom” of acupuncture, not the fantasy story told by acupuncturists and other believers to credulous journalists like Yeager, who basically accept what they’re told about qi and “life energy” and “energy flows,” in other words, the vitalistic, mystical, religious belief system underlying acupuncture, a belief system with no basis in science, and then write:

Those studies include a meta-analysis of randomized control trials with 18,000 total participants, financed by the NIH and published in JAMA Internal Medicine in 2012. This large study shows that acupuncture outperforms “sham” treatments (where needles are placed at random points or not far enough into the skin) in treating osteoarthritis, chronic headaches, and chronic back, neck, and shoulder pain.

No, no, no, no. That’s the Vickers meta-analysis, and it does not show that acupuncture works for pain. It just doesn’t. Yet every acupuncturist and believer trots this study out as definitive “proof” that acupuncture works for pain as they pontificate about their mystical magical medicine:

Chinese medicine views the body as an anatomical whole, with organs defined in terms of yin and yang. Like qi, yin and yang might sound esoteric, but Kaptchuk simply calls them “convenient labels used to describe how things function in relation to each other.”

Yin qualities are night-like: cool, dark, restful, and passive. By contrast, yang qualities are like the sun: hot, stimulating, vigorous, and active.

When we’re healthy, we maintain a balance of the two. When we have symptoms of illness, we usually have too much of one and not enough of the other. Hormonal cycles of all kinds readily reveal the interplay of yin and yang.

“There is a constant struggle to keep these two in balance, which is the root of all diagnosis and treatment in Traditional Chinese Medicine,” says Boggs. “For example, yin works to cool the body and maintain a constant temperature. So if yin becomes depleted or is insufficient, yang will increase, which increases body temperature.”

She explains how this works during menopause. “Our bodies are typically more yang during the day and yin at night. During menopause you have kidney yin deficiency, so your yang persists into the night and you have insomnia and hot flashes.”

Research bears this out. In one yearlong study of more than 200 women ages 45 to 60, acupuncture treatments reduced hot flashes and night sweats by as much as 36 percent, and improved sleep, memory, and anxiety.

No, research does not bear this out. There is a panoply of studies of acupuncture for menopause, be it natural menopause or menopause induced by the treatment of breast cancer. When carefully examined, they basically show that acupuncture does not work for menopausal hot flashes. And why should it? There is zero biological plausibility.

None of that stops Yeager from trying to convince us that acupuncture meridians are real. She even cites the work of Helene Langevin, who tried to map the anatomy of acupuncture meridians and acupuncture points on cadavers. I’ve discussed Langevin before. Her research has traditionally been—shall we say?—less than convincing.

The last section shows us the true intent of the article, which is to sell acupuncture as a treatment. Not a hint of skepticism having been shown thus far, Yeager dutifully tells the audience how they should only seek out acupuncturists certified by National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM), concluding:

Finally, the question everyone asks is: “Does it hurt?” The needles are a very fine gauge, so acupuncture is different from getting a shot. You may feel a brief sting, especially if you’re a bit dehydrated or otherwise inflamed. Once inserted, the needles also may cause slight achy or itchy sensations, but this is rare.

The sensations are almost never as bad as people expect, says Tomás Flesher, LAc, of Three Treasures Natural Healing in Minneapolis, and the relief acupuncture provides usually overrides those concerns.

“For most people, it takes only one treatment to overcome whatever fear or anxiety they have,” he says. “Once they relax and start feeling the power of what acupuncture can do, any fear they did have completely goes away.”

The only real “power” of acupuncture is to separate the mark from his cash.

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