Acupuncture for treating Bell’s palsy–myth vs. science

4acupunctureOf all of the alternative medicine therapies, acupuncture is the one that seems to get the most research money, and gets the most claims of effectiveness. Emphasize “claim”, because as of yet, there are no studies that show anything beyond a placebo effect, and some have shown results worse than placebo. Most of the studies are poorly designed, with poor control groups, with poor results.

Here are just some of the Cochrane reviews of acupuncture research that conclude that acupuncture lacks any clinical efficacy:

That’s just a few of many negative studies. 

So what is acupuncture? Its theoretical basis is that health and sickness are caused by the good or bad flow of Qi through the body, in particular along the twelve major meridians of the body (though some authorities list fourteen or even more) which run from head to toe along the body, and which are associated with the bladder, gallbladder, heart, large intestine, small intestine, kidneys, liver, lungs, spleen, stomach, pericardium, and other things. It is a form of woo medical procedure based on sticking needles into the dermis at precise points to affect the Qi. Except there is no evidence at all that this Qi exists. It’s pseudoscience.

What’s amusing is that people believe it’s some ancient Chinese practice, when, in fact, it was last used widely about 2000 years ago, until Chairman Mao brought it back during the Cultural Revolution to rid China of western ideas. Acupuncture’s roots are not in any type of traditional Chinese medicine, but was just a political tool during the Cold War. 

To sum it up, according to the good people at ScienceBasedMedicine

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 soupçon of counter-irritant.

The Myth

Despite all of the negative results, people keep trying to prove that it works. A recent study compared the use of strong acupuncture to weak acupuncture for the treatment of Bell’s palsy,  is a form of facial paralysis resulting from a dysfunction of the facial nerve causing an inability to control facial muscles on the affected side. Bell’s palsy does not include several conditions can cause facial paralysis, for example a stroke. The cause of the disorder is unknown.

The study stated that patients who had intense acupuncture stimulation (identified as strong enough to achieve de qi, one of those magical, nonexistent forces that acupuncturists think exist) regained more muscle movement of the face, reduced disability and improved quality of life. The authors of the paper conclude that “Among patients with Bell palsy, acupuncture with strong stimulation that elicited de qi had a greater therapeutic effect, and stronger intensity of de qi was associated with the better therapeutic effects.”

Well, that settles it. And some “science” writers are trumpeting the results without the level of critical examination that many of us have demanded from science journalists.

The science

Where do I start?

Supposedly, this is a “randomized controlled trial“, but it really doesn’t have a true control group. In this study, the control group is also receiving acupuncture. But where are the trials that compare acupuncture (which causes the pseudoscientific de qi) to current therapies that have known clinical benefits such as steroids? We can’t even determine if they are reporting placebo effects, because we don’t know if the effects are an actual improvement over no treatment. Or clinically proven ones.

So without even going forward with a discussion of the potential viability of acupuncture for treating Bell’s palsy, one would have to conclude that this study doesn’t tell anyone anything, except one form of acupuncture might be better than another. But we don’t know if either are helpful at all.

Of course, we have strong evidence that acupuncture is actually useless for Bell’s palsy. Cochrane Reviews, one of the best sources for reviewing clinical studies, has reviewed six studies that examined the treatment of Bell’s palsy with acupuncture. Their conclusion: “The quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture. More research with high quality trials is needed.” Don’t take that as “well, we haven’t tried hard enough”, take it as “they tried and found nothing.”

Any positive results attributed to acupuncture (even ignoring the poor quality of the study discussed in this post) probably arise from a few reasons:

  1. The placebo effect may be responsible. Through suggestion, belief, expectancy, cognitive reinterpretation, and diversion of attention, patients given biologically useless treatments often experience measurable relief. Some placebo responses produce actual changes in the physical condition; others are subjective changes that make patients feel better even though there has been no objective change in the underlying pathology.
  2. Temporary mood improvement can be confused with cure. Alternative healers often have forceful, charismatic personalities. To the extent that patients are swept up by the messianic aspects of “alternative medicine,” psychological uplift may ensue.
  3. Psychological needs can distort what people perceive and do. Even when no objective improvement occurs, people with a strong psychological investment in “alternative medicine” can convince themselves they have been helped. According to cognitive dissonance theory, when experiences contradict existing attitudes, feelings, or knowledge, mental distress is produced.

My conclusion: there’s nothing in the Xu et al. article about acupuncture for Bell’s palsy that is convincing evidence that it can do anything significant for the disease. 

Key citations:

The Original Skeptical Raptor
Chief Executive Officer at SkepticalRaptor
Lifetime lover of science, especially biomedical research. Spent years in academics, business development, research, and traveling the world shilling for Big Pharma. I love sports, mostly college basketball and football, hockey, and baseball. I enjoy great food and intelligent conversation. And a delicious morning coffee!