A private watchdog group, the National Council Against Health Fraud has stated:

• Acupuncture is an unproven modality of treatment.
• Its theory and practice are based on primitive and fanciful concepts of health and disease that bear no relationship to present scientific knowledge.
• Research during the past 20 years has not demonstrated that acupuncture is effective against any disease.
• Perceived effects of acupuncture are probably due to a combination of expectation, suggestion, counter-irritation, conditioning, the regressive fallacy and other psychological mechanisms.
• The use of acupuncture should be restricted to appropriate research settings.
• Insurance companies should not be required by law to cover acupuncture treatment.
• Licensure of lay acupuncturists should be phased out.
• Consumers who wish to try acupuncture should discuss their situation with a knowledgeable physician who has no commercial interest.

Reference: Sampson W and others. Acupuncture: The position paper of the National Council Against Health Fraud. Clinical Journal of Pain 7:162-166, 1991.

A Consensus Development Conference held in 1997, sponsored among others by the National Institutes of Health stated:

Despite considerable efforts to understand the anatomy and physiology of the “acupuncture points”, the definition and characterization of these points remains controversial. Even more elusive is the basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and the five phases theory, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture.

In short, the treatment and diagnosis of acupuncturists are not based on concepts that blend well with those used by contemporary Western medical science.

Three Dutch epidemiologists have analyzed 51 controlled studies of acupuncture, in which acupuncture was used to treat chronic pain. Their conclusion was that

the quality of even the better studies proved to be mediocre. . . . The efficacy of acupuncture in the treatment of chronic pain remains doubtful.

Reports of acupuncture used to treat various addictions (heroin, cigarettes, alcohol) were also analyzed. The conclusion was that

claims that acupuncture is effective as a therapy for these conditions are not supported by sound clinical research.

References: Ter Riet G, Kleijnen J, Knipschild P.: ‘Acupuncture and chronic pain: A criteria-based meta-analysis. Clinical Epidemiology 43:1191-1199, 1990’ and (from the same authors) ‘A meta-analysis of studies into the effect of acupuncture on addiction. British Journal of General Practice 40:379-382, 1990.’

The University of Heidelberg has developed a “fake needle” to use as placebo-needle. It is a needle with a blunt tip that can slide into the handle, giving the illusion that it penetrates the skin. In tests, volunteers did not notice that the needle did not actually penetrate their skin (Reference: Streitberger K, Kleinhenz J. Introducing a placebo needle into acupuncture research. Lancet 352:364-365, 1998). They used this needle in 2004 in a study of postoperative nausea and vomiting (PONV) in women who underwent breast or gynecologic surgery. The group consisted of 220 women. Acupuncture was applied on the acupuncture point “Pericardium 6 (P6),” which is on the inside of the forearm. Part of the group was treated with real needles, the other part (the control group) with the fake needles. They reported: ‘We could not prove our hypothesis that acupuncture is more effective than placebo acupuncture in the prevention of

PONV.’ (or to put it more plainly) ‘There was almost no difference in the occurrence of PONV between acupuncture (38.7%) and placebo (40.3%) in the subgroup of patients having breast surgery. ‘ (Reference: Streitberger K and others: Acupuncture compared to placebo-acupuncture for postoperative nausea and vomiting prophylaxis: A randomised placebo-controlled patient and observer blind trial. Anesthesia 59:142-149, 2004.)

What is less often remarked upon is that the Heidelberg study above went on to comment:

PONV was reduced by acupuncture about 18.5% (from 67.4% to 48.9%) in the subgroup of patients with gynaecological surgery, which was close to our expectation of a reduction of 20%. Therefore, our study might suggest that acupuncture is effective for PONV prophylaxis in patients having gynaecological surgery but not in those having breast surgery. However, our study had insufficient power for this question because it was not designed to prove this new hypothesis.

They noted that previous studies found that acupuncture worked particularly well on gynaecological surgery. They also pointed out that

A statistically significant result was achieved in the secondary outcome criteria of vomiting within 24 h after surgery.

but that, again, this result had to be viewed with caution as

Positive results in secondary endpoints or subgroup analysis might be due to multiple testing.

A more recent 2004 meta-analysis of the effects the same (P6) acupoint on Post-Operative Nausea and Vomiting (PONV) stated that

Twenty-six trials (n = 3347) were included, none of which reported adequate allocation concealment

(Allocation concealment prevents researchers from (unconsciously or otherwise) influencing which participants are assigned to a given intervention group.)

There were significant reductions in the risks of nausea (RR 0.72, 95% CI 0.59 to 0.89), vomiting (RR 0.71, 95% CI 0.56 to 0.91) and the need for rescue antiemetics (RR 0.76, 95% CI 0.58 to 1.00) in the P6 acupoint stimulation group compared with the sham treatment, although many of the trials were heterogeneous. There was no evidence of difference in the risk of nausea and vomiting in the P6 acupoint stimulation group versus individual antiemetic groups. However, when different antiemetics were pooled, there was significant reduction in the risk of nausea but not vomiting in the P6 acupoint stimulation group compared with the antiemetic group (RR 0.70, 95% CI 0.50 to 0.98; RR 0.92, 95% CI 0.65 to 1.29 respectively). The side effects associated with P6 acupoint stimulation were minor.

The reviewers concluded:

This systematic review supports the use of P6 acupoint stimulation in patients without antiemetic prophylaxis. Compared with antiemetic prophylaxis, P6 acupoint stimulation seems to reduce the risk of nausea but not vomiting.

Of course, this meta-analysis has been criticised for the lack of allocation concealment in any of the trials.

• Cochrane Library meta-analysis of the effect of the P6 acupuncture point on PONV

In a recent study it was discovered that genuine acupuncture needles created objective changes in brain states as measured by positron emission tomography (PET), as opposed to the use of sham needles, especially in brain areas related to pain reduction. But random placement of the needles (placebo acupuncture) also had that effect. The authors of the study state: ‘These results suggest that real acupuncture has a specific physiological effect’

• Expectancy and belief modulate the neuronal substrates of pain treated by acupuncture, NeuroImage, 25, 4

According to the NIH Consensus Statement on Acupuncture:

Acupuncture as a therapeutic intervention is widely practiced in the United States. While there have been many studies of its potential usefulness, many of these studies provide equivocal results because of design, sample size, and other factors. The issue is further complicated by inherent difficulties in the use of appropriate controls, such as placebos and sham acupuncture groups. However, promising results have emerged, for example, showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain. There are other situations such as addiction, stroke rehabilitation, headache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, carpal tunnel syndrome, and asthma, in which acupuncture may be useful as an adjunct treatment or an acceptable alternative or be included in a comprehensive management program. Further research is likely to uncover additional areas where acupuncture interventions will be useful.

• NCCAM research summaries on acupuncture

Another Cochrane meta-analysis probably sums up the status quo best:

Overall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions.

• Cochrane review of acupuncture for idiopathic headache.

The British Medical Journal reports ( DOI: 10.1136/bmj.38512.405440.8F ) that in a study of 270 tension headache sufferers in Munich, needles inserted at random points on the body were just as effective as needles inserted at traditional acupuncture points. This would suggest that any observed effect is due to the body’s response to the needles, rather than the interaction with the claimed “energy flows”.

• BMJ Abstract

Proponents continue to claim that the scientific jury is still out on the effectiveness of acupuncture, with existing evidence slightly favouring the proposition that it can be effective in some cases for some conditions. However, almost all the research on the effectiveness of acupuncture is of poor quality and can be criticised on various grounds. The validity of acupuncture is discounted by a great majority of the mainstream medical and scientific community and much more research (of a much higher quality) would need to be done before the effectiveness of acupuncture could be accepted within the medical community.

See: http://nccam.nih.gov/health/acupuncture/

[source: wikipedia]

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