Puncturing the Acupuncture Myth (via Science-Based Medicine)
“Alternative” medicine is by definition medicine that has not been scientifically proven and has not been accepted into mainstream scientific medicine. The question I keep hearing is, “But what about acupuncture? It’s been proven to work, it’s supported by lots of good research, more and more doctors are using it, and insurance companies even pay for it.”
To start with, this ancient Chinese treatment is not so ancient and may not even be Chinese! From studying the earliest documents, Chinese scholar Paul Unschuld suspects the idea may have originated with the Greek Hippocrates of Cos and later spread to China. There’s certainly no evidence that it’s 3000 years old. The earliest Chinese medical texts, from the 3rd century BC, don’t mention it. The earliest reference to “needling” is from 90 BC, but it refers to bloodletting and lancing abscesses with large needles or lancets. There is nothing in those documents to suggest anything like today’s acupuncture. We have the archaeological evidence of needles from that era – they are large; the technology for manufacturing thin steel needles appropriate for acupuncture didn’t exist until 400 years ago.
The earliest accounts of Chinese medicine reached the West in the 13th century: they didn’t mention acupuncture at all. The first Westerner to write about acupuncture, Wilhelm Ten Rhijn, in 1680, didn’t describe acupuncture as we know it today: he didn’t mention specific points or “qi;” he spoke of large gold needles that were implanted deep into the skull or “womb” and left in place for 30 respirations.
Acupuncture was tried off and on in Europe after that. It was first tried in America in 1826 as a possible means of resuscitating drowning victims. They couldn’t get it to work and “gave up in disgust.” I imagine sticking needles in soggy dead bodies was pretty disgusting.
Through the early 20th century, no Western account of acupuncture referred to acupuncture points: needles were simply inserted near the point of pain. Qi was originally vapor arising from food, and meridians were channels or vessels. A Frenchman, Georges Soulie de Morant, was the first to use the term “meridian” and to equate qi with energy – in 1939. Auricular (ear) acupuncture was invented by a Frenchman in 1957.
The Chinese government tried to ban acupuncture several times between 1822 and WWII, when the Chinese Nationalist government tried to suppress it. Mao revived it in the “barefoot doctor” campaign in the 1960s as a cheap way of providing care to the masses; he did not use it himself and he did not believe it worked. It was Mao’s government that coined the term “traditional Chinese medicine” or TCM, to include acupuncture, herbal medicine, moxibustion, and other traditional practices.
(Mao’s Barefoot Doctors Propaganda poster)
As acupuncture increased in popularity in the West, it declined in the East. In 1995, visiting American physicians were told only 15-20% of Chinese chose TCM, and it was usually used along with Western treatments after diagnosis by a Western-trained physician. Apparently some patients choose TCM because it is all they can afford: despite being a Communist country, China does not have universal health coverage.
Does acupuncture work? Which acupuncture, and what do you mean by work? There are various different Chinese systems, plus Japanese, Thai, Korean and Indian modalities, most of which have been invented over the last few decades. Whole body or limited to the scalp, hand, ear, foot, or cheek and chin. Deep or superficial. With electrified needles. With lasers. With dermal pad electrodes and no skin penetration.
Acupuncture works, but placebos work too. Acupuncture has been shown to “work” to relieve pain, nausea, and other subjective symptoms, but it has never been shown to alter the natural history or course of any disease. It’s mostly used for pain today, but early Chinese practitioners maintained that it was not for the treatment of manifest disease, was so subtle that it should only be employed at the very beginning of a disease process, and was only likely to work if the patient believed it would work. Now there’s a bit of ancient wisdom!
Studies have shown that acupuncture releases natural opioid pain relievers in the brain: endorphins. Veterinarians have pointed out that loading a horse into a trailer or throwing a stick for a dog also releases endorphins. Probably hitting yourself on the thumb with a hammer would release endorphins too, and it would take your mind off your headache.
Psychologists can list plenty of other things that could explain the apparent response to acupuncture. Diverting attention from original symptoms to the sensation of needling, expectation, suggestion, mutual consensus and compliance demand, causality error, classic conditioning, reciprocal conditioning, operant conditioning, operator conditioning, reinforcement, group consensus, economic and emotional investment, social and political disaffection, social rewards for believing, variable course of disease, regression to the mean – there are many ways human psychology can fool us into thinking ineffective treatments are effective. Then there’s the fact that all placebos are not equal – an elaborate system involving lying down, relaxing, and spending time with a caring authority can be expected to produce a much greater placebo effect than simply taking a sugar pill.
There are plenty of studies showing that acupuncture works for subjective symptoms like pain and nausea. But there are several things that throw serious doubt on their findings. The results are inconsistent, with some studies finding an effect and others not. The higher quality studies are less likely to find an effect. Most of the studies are done by believers in acupuncture. Many subjects would not volunteer for an acupuncture trial unless they had a bias towards believing it might work.
The biggest problem with acupuncture studies is finding an adequate placebo control. You’re sticking needles in people. People notice that. Double blinding is impossible: you might be able to fool patients into thinking you’ve used a needle when you haven’t, but there’s no way to blind the person doing the needling. Two kinds of controls have been used: comparing acupuncture points to non-points, and using an ingenious needle in a sheath that appears to have penetrated the skin when it hasn’t.
In George Ulett’s research, he found that applying an electrical current to the skin of the wrist – a kind of TENS (transcutaneous electrical nerve stimulation) treatment – worked just as well as inserting needles, and one point on the wrist worked for symptoms anywhere in the body.
Guess what? It doesn’t matter where you put the needle. It doesn’t matter whether you use a needle at all. In the best controlled studies, only one thing mattered: whether the patients believed they were getting acupuncture. If they believed they got the real thing, they got better pain relief – whether they actually got acupuncture or not! If they got acupuncture but believed they didn’t, it was less likely to work. If they didn’t get it but believed they did, it was more likely to work.
Acupuncturists can rationalize with great ingenuity. In a recent study using sham acupuncture as a control, both the sham placebo acupuncture and the true acupuncture worked equally well and were better than no treatment. The obvious conclusion was that acupuncture was no better than placebo. Their conclusion was that acupuncture worked and the placebo acupuncture worked too!
One researcher decided it’s not meaningful to use placebo controls in acupuncture research because any stimulation of the skin might be effective – which seems to me to pretty much destroy the whole rationale for acupuncture, but he didn’t seem to notice that. If that’s true, why not just caress or massage our patients instead of lying about imaginary qi and meridians?
Considering the inconsistent research results, the implausibility of qi and meridians, and the many questions that remain, all the current evidence is compatible with this hypothesis: acupuncture is nothing more than a recipe for an elaborate placebo seasoned with a soupcon of counter-irritant. That is what R. Barker Bausell concluded in his book Snake Oil Science. The world’s first professor of complementary medicine, Dr. Edzard Ernst, is more accepting of low-prior-plausibility evidence than some of us; but even he used the words “tentative” and “might” when he recently wrote, “While there is tentative evidence that acupuncture might be effective for some forms of pain relief and nausea, it fails to deliver any medical benefit in any other situations and its underlying concepts are meaningless.”
1 If Humans Came From Apes, Why Aren’t Apes Evolving Into Humans?
Humans, apes, and monkeys are only distant evolutionary “cousins.” We come not from apes but from a common ancestor that was neither ape nor human that lived millions of years in the past. In fact, during the last seven million years many human-like species have evolved; some examples include Homo habilis, Homo erectus, and Homo neanderthalensis. All of these went extinct at different times, leaving just us to share the planet with a handful of other primates.
2 There Are Too Many Gaps in the Fossil Record for Evolution to Be True
In fact, there are lots of intermediate fossils. Archaeopteryx, for example, is one of the earliest known fossil birds with a reptilian skeleton and feathers. There is now evidence that some dinosaurs had hair and feathers. Therapsids are the intermediates between reptiles and mammals, Tiktaalik is an extinct lobe-finned fish intermediate to amphibians, there are now at least six intermediate fossil stages in the evolution of whales, and in human evolution there are at least a dozen intermediate fossil stages since hominids branched off from the great apes six million years ago. Considering the exceptionally low probability that a dead plant or animal will fossilize it is remarkable we have as many fossils as we do. First the dead animal has to escape the jaws of scavengers. Then is has to be buried under the rare circumstances that will cause it to fossilize instead of decay. Then geological forces have to somehow bring the fossil back to the surface to be discovered millions of years later by the handful of paleontologists looking for them
3 If Evolution Happened Gradually Over Millions of Years Why Doesn’t the Fossil Record Show Gradual Change?
Sudden changes in the fossil record are not missing evidence of gradualism; they are extant evidence of punctuation. Species are stable over long periods of time and so they leave plenty of fossils in the strata while in their stable state. The change from one species to another, however, happens relatively quickly (on a geological time scale) in a process called punctuated equilibrium. One species can give rise to a new species when a small “founder” group breaks away and becomes isolated from the ancestral group. This new founder group, as long as it remains small and detached, may experience relatively rapid change (large populations are genetically stable). The speciational change happens so rapidly that few fossils are left to record it. But once changed into a new species, the individuals will retain their phenotype for a long time, leaving behind many well-preserved fossils. Millions of years later this process results in a fossil record that records mostly stability. The punctuation is there in between the equilibrium.
4 No One Has Ever Seen Evolution Happen
Evolution is a historical science confirmed by the fact that so many independent lines of evidence converge to this single conclusion. Independent sets of data from geology, paleontology, botany, zoology, biogeography, comparative anatomy and physiology, genetics, molecular biology, developmental biology, embryology, population genetics, genome sequencing, and many other sciences each point to the conclusion that life evolved. Creationists demand “just one fossil transitional form” that shows evolution. But evolution is not proved through a single fossil. It is proved through a convergence of fossils, along with a convergence of genetic comparisons between species, and a convergence of anatomical and physiological comparisons between species, and many other lines of inquiry. (In fact we can see evolution happen—especially among organisms with short reproductive cycles that are subject to extreme environmental pressures. Knowledge of the evolution of viruses and bacteria is vital to medical science.)
5 Science Claims That Evolution Happens by Random Chance
Natural selection is not “random” nor does it operate by “chance.” Natural selection preserves the gains and eradicates the mistakes. To illustrate this, imagine a monkey at a typewriter. In order for the monkey to type the first 13 letters of Hamlet’s soliloquy by chance, it would take 26 (to the 13th power) number of trials for success. This is 16 times as great as the total number of seconds that have elapsed in the lifetime of the solar system. But if each correct letter is preserved and each incorrect letter eradicated, the phrase “tobeornottobe” can be “selected for” in only 335 trials, or just seconds in a computer program. Richard Dawkins defines evolution as “random mutation plus nonrandom cumulative selection.” It is the cumulative selection that drives evolution. The eye evolved from a single, light sensitive spot in a cell into the complex eye of today not by chance, but through thousands of intermediate steps, each preserved because they made a better eye. any of these steps still exist in nature in simpler organisms.
6 Only an Intelligent Designer Could Have Made Something as Complex as an Eye
The anatomy of the human eye shows that it is anything but “intelligently designed.” It is built upside down and backwards, with photons of light having to travel through the cornea, lens, aqueous fluid, blood vessels, ganglion cells, amacrine cells, horizontal cells, and bipolar cells, before reaching the light sensitive rods and cones that convert the light signal into neural impulses, which are then sent to the visual cortex at the back of the brain for processing into meaningful patterns. For optimal vision, why would an intelligent designer have built an eye upside down and backwards? This “design” only makes sense if natural selection built eyes from available materials, and in the particular configuration of the ancestral organism’s pre-existing organic structures. The eye shows the pathways of evolutionary history, not intelligent design.
7 Evolution is Only A Theory
All branches of science are based on theories, which are grounded in testable hypothesis and explain a large and diverse body of facts about the world. A theory is considered robust if it consistently predicts new phenomena that are subsequently observed. Facts are the world’s data. Theories are explanatory ideas about those data. Constructs and other non-testable statements are not a part of science. The theory of evolution meets all the criteria of good science, as determined by Judge William Overton in the Arkansas creationism trial:
• It is guided by natural law.
• It has to be explanatory by reference to natural law.
• It is testable against the empirical world.
• Its conclusions are tentative.
• It is testable and falsifiable.
If you can find fossil mammals in the same geological strata as trilobites then evolution would be falsified. No one has ever found such contradictory data.
8 Evidence for Human Evolution Has Turned Out to Be Fake, Frauds, or Fanciful
Eager to discredit evolution, creationists ignore hominid fossil discoveries and cherry pick examples of hoaxes and mistakes in the belief that mistakes in science are a sign of weakness. This is a gross misunderstanding of the nature of science, which constantly advances by using both its mistakes and the successes. Its ability to build cumulatively on the past is how science progresses. The self-correcting feature of the scientific method is one of its most powerful assets. Hoaxes like Piltdown Man, and honest mistakes like Nebraska Man, Calaveras Man, and Hespero-pithecus, are, in time, corrected. In fact, it wasn’t creationists who exposed these errors, it was scientists who did so. Creationists simply read about the scientific exposé of these errors, and then duplicitously claimed them as their own.
9 The Second Law of Thermodynamics Proves That Evolution is Impossible
The Second Law of Thermodynamics applies to closed, isolated systems. Since the Earth receives a constant input of energy from the sun—it is an open-dissipative system—entropy may decrease and order increase (though the sun itself is running down in the process). Thus, the Earth is not strictly a closed system and life may evolve without violating natural law. As long as the sun is burning, life may continue thriving and evolving, just like automobiles may be prevented from rusting, burgers can be heated in ovens, and all manner of things in apparent violation of Second Law entropy may continue. But as soon as the sun burns out, entropy will take its course and life on Earth will cease.
10 Evolution Can’t Account For Morality
As a social primate species we evolved a deep sense of right and wrong in order to accentuate and reward reciprocity and cooperation, and to attenuate and punish excessive selfishness and free riding. As well, evolution created the moral emotions that tell us that lying, adultery, and stealing are wrong because they destroy trust in human relationships that depend on truth-telling, fidelity, and respect for property. It would not be possible for a social primate species to survive without some moral sense. On the constitution of human nature is built the constitutions of human societies.