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Is acupuncture, like, legit now?
I remember a time when acupuncture was universally condemned as bogus pseudoscience, and I was under the impression that that remained true. However, looking for negative takes on acupuncture on YouTube is almost impossible now. Almost everything is overwhelmingly positive, including content produced by medical doctors. I could only find a few negative videos. They were short, not very good, and not very popular.
This is a sincere question: am I really out of touch, or has everyone gone crazy?
Anecdotally, I did acupuncture without believing in it, and it didn't do anything for me.
Here is a study that you might find illuminating.
This study was done to determine if real acupuncture and "fake" acupuncture were effective at treating chronic lower back pain. They mention in the abstract that a few strong European studies found that the location of the needle didn't have any effect on the effectiveness of acupuncture in those studies I.e. placing the needle in energy meridians doesn't matter, you can put them wherever and the outcome is the same. They made a four armed randomized and double-blind study where they tested individualized acupuncture, standardized acupuncture, non insertive acupuncture (using a toothpick to simulate the sensation of acupuncture), and standard care.
Long story short, all forms of acupuncture did much better than standard care [edited to add: they all performed better by roughly the same amount; any slight differences were neither statistically nor meaningfully significant in terms of treatment effectiveness.] And since we know that location of needle doesn't matter (location being of utmost importance in the practice), there is no difference in individualized or standard, and it doesn't even require breaking the skin (also of utmost importance)...
The correct interpretation of this is that purported effectiveness of acupuncture is placebo.
Here is the article in JAMA
https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/414934
*edited for typos, and added context
Excelent study. I do want to edatorialize a little bit and point out to others that just because it's placebo doesn't make it fake, if it works - it works. A great deal of study has been found that the simple fact of visiting a doctor's office makes people feel better, we like to think of ourselves as more culturally evolved than tribal societies but it's time to admit that ritual and placebo still carry enourmous weight for our psyches and that our psyches play a big role in the function of our bodies and how we feel overall
This isn't correct.
Placebo has a measurable effect, yes. However the placebo effect has a short halflife, and most importantly, is not medicine. The study in question shows that it doesn't really matter what you do, the acupuncture has the same effect as placebo. There is no justification for taking people's money for essentially doing nothing.
I would argue that because our psyches are indeed such a large part of our health, that extra care should be taken to ensure that the medicine we use actually works.
Also just because an indigenous culture may have a tradition of using herbll lore that does have measurable pharmacological effect, in no way validates any other traditional medicine practice out of hand. They must all be taken on a case by case basis.
The short of it: acupuncture has demonstrated some legitimate success in mitigating chronic pain, though the traditional Chinese medicine aspects don't seem to matter at all and it's more about sticking needles in you. It still cannot do everything else people were saying it can do.
Are there any peer reviewed double blind studies published in a medical journal that show any amount of success for accupuncture? I certainly give it even less plausability at the moment than chiropractic therapy (which has been shown to be harmful in many cases). The good chiropractors are basically phisical therapists who will teach you stretches and strength training movements. In which case it makes more sense to see a licenced physical therapist. I'm happy to change my viewpoint, but without peer reviewed scientific evidence, I am not inclined to do so, or even argue any of the finer points.
It seems to me there's a lot of societal pressure behind things like accupuncture, but that doesn't make it legitimate on its own. My guess: it's probably not any more reliable than a placebo. We would be better served to push message therapy as a treatment for chronic pain, it will at least be more enjoyable for the people getting it, and help with anxiety which is linked to chronic pain.
Could you have a controlled study at all here? There’s no way to convince the control group they’ve had the treatment that I can think of, so you’re left analysing not the treatment in isolation.
I left a comment elsewhere in this thread linking to a study that did just that. They created "sham" acupuncture by having the subject lie face down with an eye mask, and used needle guiding tubes, but poked the skin with a toothpick instead of the needle creating a simulated experience of acupuncture.
That's a super cool approach!
I see. So there's an inflation of claims. I see it recommended for pretty much anything.
My understanding is if you have muscle pain (or other pain caused by muscles issues) acupuncture could help relieve symptoms, much like a massage.
But if you have depression, sticking a bunch of needles in your ears won't heal you beyond the fact that you now have needles in your ears and wtf is up with that???
I mean, next time you get depressed you can just think "Remember when I was so depressed I stabbed a bunch of needles in my ear?" And have a good laugh about that which may cure the depression.
Also anecdotally I did acupuncture without believing in it. It was done by a private (aka, paid for, not NHS - although the NHS also offer acupuncture) physiotherapist, not a Chinese medicine practitioner - and it really helped me a lot. Helped even more when she wired up a TENS machine to the needles and turned that one.. It only helped with symptoms, it didn't do anything to address the underlying issues, but sometimes it's nice to just have some time when things just don't hurt for a bit.
Acupuncture appears to have some effect on certain types of pain. But it's very hard to conduct trials on, because how do you placebo poking a needle into someone? Either you stick them or you don't, there's no way to control for acupuncture. Especially when acupuncturists insist that pressure works as well as needling, so you can't just tap people as a control. See also, weighted blankets for anxiety - they appear to help lots of people but you can't fake a weighted blanket in a double blind trial situation.
There's an awful of lot good that can be done by just lying people down for half and hour and paying attention to them. For example, reflexology helps my back pain despite everything in me screaming it's utter nonsense. Although I didn't go back and pay for a second session, of course. Someone once gave me reiki and even that reduced my pain despite them barely touching me the whole time. A darkened room with some incense and chilled out music is just good for some types of pain and stress. And it seems like having a practitioner there also helps - even if they don't touch you - it doesn't work so well on your own. So we shouldn't discount the good being done by these kind of therapies as a positive.
Although anyone recommending acupuncture or any other complementary therapy for anything for which we have better, clinically proven treatments - such as cancer or whatever - shouldn't. And I mean that in a very legally binding way.
The placebo effect is real, and I don’t understand why we aren’t studying it more closely. Probably because it can’t be as effectively monetized.
That said, I am slow to discount alternative therapies. The universe is far vaster than we yet know, and just because something doesn’t fit inside existing paradigms doesn’t mean it’s not real.
One problem with alt therapies, even if they are real, is that not every practitioner is legitimate, and even among those who truly believe themselves to be, competency is hard to determine. And even if it is a legit therapy and competent practitioner, there may not be enough information to determine whether it/they are right for you and your condition. As you point out, many of these therapies do not easily yield to RCTs. Same with many mental health therapies as well.
A good start would be some kind of high integrity reporting mechanism of people’s experiences. I stop short of saying standardized, not because it’s not a good idea, but because it’s too far away for now. But imagine a kind of npr style funded underwriters laboratories.
There has not been a significant change in the medical literature on the effectiveness of acupuncture in the positive direction.
The factor that I think many people in this thread and in the wider world miss, is that the Supplement, Complimentary and Alt Med industry is a billion dollar industry, and just like any large industry, they have lobbyists that effect change to the benefit of said industry.
For example, the supplement industry in specific lobbied the government and spent a lot of money on advertising campaigns in the 90s (featuring mel Gibson) to prevent herbal supplements (which in theory, have pharmacological effects) from being regulated the same as drugs, and instead as dietary supplements, which is significantly less strict when it comes to ingredient consistency and no need for proof of efficacy.
It is also self regulated, as in they aren't allowed to adulterate the product, but they are the ones to confirm this. The FDA can issue recalls if the product is adulterated, but depends on customer reporting. Please see this article, followed by this policy change. Keep in mind that this is only one drug store chain, and they weren't already doing this.
Aaanyway, acupuncture, chiropractic, and many other forms of alt med are covered by most insurance, not because they work, but because they have been successfully lobbied for by the alt med industry. Why else would insurance cover Christian Scientist Faith Healing? It does, it's crazy.
To belabor the point, there is a financial incentive to the insurance industry to shunt patients off onto the alt med industry for cheaper procedures that they cover, and a benefit to the alt med industry because in most cases (and as seen in this thread) they are using placebo to manage symptoms, not treat underlying issues, which means the patients will continue to return for pain management, and spend more and more money.
There has been no improvement in care, just more capitalisms race to the bottom.
As for placebo: it is not now, nor has it ever been good or ethical medicine to treat people suffering from non psychosomatic illnesses with placebo.
Full stop.
If this were to be allowed as standard practice (and I'm going to be a bit perjorative here to illustrate my point) your insurance, instead of paying for more expensive treatment that has been proven to work, could refer you to your local witch doctor, who might sponge bathe you with animal blood, or wave a stick over you, yelling at your illness demons to leave.
"Well I went to Old Man Dennis, who lives in the swamp, and my sciatic pain went right away. Of course I have to go back every two weeks for maintenance, but I'm glad to spend my money for a little relief".
Now you might say "but MrAlex, that sounds exactly like what we already do with acupuncture or chiropractic, and we aren't sending people to witch doctors or exorcists!"
My point is it is exactly the same. The only difference is that there is no organized self accrediting industry of witch doctors, lobbying the govt and insurance for the vaneer of legitimacy through insurance billing. And continuing to take money from people who are suffering while not offering them any permanent improvement is predatory and unethical.
The first standard other than safety that should be used to determine what should and should not be used to treat patients in the broad sense is whether it has been proven to work, or it hasn't.
I am happy that some people in the comments have seen some relief, but anecdotal experience is not sufficient to determine if a medical intervention is effective or should be promoted.
Thank you for reading my bitter screed.
I wouldn’t say “now” per se. As with any med tech, the evidence accumulates. I understand that that’s your impression from YouTube, but acceptance in popular culture is not a good standard for the legitimacy of a medicine. Not the least because they are usually fads or viral phenomena often driven by random events.
Here is a “recent” review from 2011 that describes the plausible mechanism:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3092510/
Why are you going to YouTube for answering scientific questions? Sure, there are experts on there, but they still have biases (science is not done by individuals) and they are still subject to YouTube's algorithm, which favors anything popular. You might as well ask your book club.
My physical therapist offered dry needling - which is if I understood correctly acupuncture without the woo. It's needles put on trigger points and the like, based on where your pain is.
Ironicaly it's not covered by my/most insurance but acupuncture is. It did not help me, but I did one session and I'm not capable of just lying still like that so I absolutely moved muscles with needles in them and 0/10 do not recommend.
However research on dry needling might be worth looking into alongside acupuncture if you're looking for effectiveness information.
Sorry what? First off, save the personal insults. Secondly "woo" here being the "non-scientific" stuff. I don't care about what anyone believes, I was sharing what I was told was an evidenced based practice even though it didn't work for me personally AND I specifically suggested looking at both.
That is the basis of this question though, is there a factual basis or is any positive result placebo? To take things further, would someone who believed in the treatment listen to what some rando was saying on the Internet, or might they already have some doubt? On the other end of the spectrum, those that are 100% believers or 100% opposed, they are unlikely to be swayed either way.
My understanding is we know it works in many contexts, there's an empirically observed benefit, vut there's no understanding as to why. The major suspect is a placebo effect, but if it still works it still works
I've had great success with acupuncture... but I also had a crazy reiki experience, so who knows. I might be a sucker for this stuff.
A few weeks ago my back and shoulder was so sore. I went in for a massage and that wasn't doing anything. I got stabbed a few times and almost immediately felt relief.
Placebo or not, I don't care. It works for me and I am totally fine with that.
The English NICE recommend acupressure as an adjunct treatment for nausea in pregnant people: https://www.nice.org.uk/guidance/ng201
The evidence review for that is here: https://www.nice.org.uk/guidance/ng201/evidence/r-management-of-nausea-and-vomiting-in-pregnancy-pdf-331305934365
But during labour the advice is "do not offer, but support if wanted: https://www.nice.org.uk/guidance/ng235/chapter/Recommendations#pain-relief-during-labour
(I'm too lazy to track the changes, but I'd be interested to know if it was previously "do not do").