Recently, I read an article in the Medical Journal of Australia that lists “156 health care practices identified and flagged through the search platform as potentially unsafe, ineffective or inappropriate in certain circumstances (pdf).” They cover procedures from prostatectomies to arterial stenting that lack evidence to support their continued use in many circumstances. Unsurprisingly, the list examined acupuncture research and found it lacking – it’s not medicine.
I know, people will get all upset. They’ll throw out anecdotes, like people do with chiropractic, or cherry pick poorly designed studies to “prove” that acupuncture works. They’ll try to convince everyone who will listen that it’s some sort of racism of Western based “mainstream” medicine that dismisses acupuncture. Because if it worked for your cousin’s daughter’s hairdresser’s uncle, it must be real medicine.
However, the overwhelming opinion of evidence based medicine is that acupuncture does not work. In the article, “An industry of worthless acupuncture studies,” Steven Novella concludes,
There are now thousands of acupuncture studies looking at every indication you can imagine (which stretches credulity that there is any common underlying mechanism). We are well past the time for preliminary studies. Despite thousands of studies, there isn’t a single indication for which real acupuncture has been shown to work to a high degree of confidence. At this point I would say that acupuncture should be abandoned as a scientific concept. It is a failed hypothesis that has added no real knowledge to our understanding of health and disease.
If, however, you are going to spend the resources to do an acupuncture study, make sure it is rigorous enough to add new information, and isn’t just another preliminary study to throw on the pile and get another round of misleading headlines about how “acupuncture” works. Of course a cynical person might suspect that this is the real goal of these studies.
I’m not going to review all 150 plus medical procedures that fail to meet the standards of evidence based medicine. That would be a book! But let’s focus on what they say about acupuncture research. Spoiler alert – it doesn’t work.
What is acupuncture?
Acupuncture is a procedure in which thin needles are inserted into the body in an attempt to alleviate a large number of maladies. It is a form of alternative medicine, which generally means faux medical procedures that lack evidence in support of their use. Acupuncture is also considered a key part of what is known as “traditional Chinese medicine” (TCM), which is not based upon scientific knowledge or evidence. Furthermore, acupuncture is considered a pseudoscience, meaning it is not based on evidence gathered by the scientific method.
Even though acupuncture is considered “traditional Chinese medicine,” the techniques use vary widely from country to country. But for the purpose of this article, we’ll focus on the acupuncture used in the USA and other “western” countries, which is mostly used for pain relief.
Scientific research has not found any biological evidence for concepts, such as qi, meridians, and acupuncture points, that are a traditional part of all acupuncture techniques. In other words, science has shown that acupuncture is pseudoscience, and the basic beliefs regarding how acupuncture works is pseudoscience.
What does acupuncture research say about acupuncture?
Back to the Medical Journal of Australia article – let’s look at specific acupuncture “procedures,” and see how they fair in peer-reviewed literature.
- Acupuncture for induction of labor – in a meta review, the highest form of scientific evidence in medicine, from Cochrane (see Note 1), the length of labor was shorter in control group (usual care) compared with acupuncture. Moreover, they found no difference for caesarean deliveries, neonatal seizures, and other parameters between the control group (or usual care) versus acupuncture.
- Acupuncture for uterine fibroids – According to another meta review from Cochrane, there is no credible evidence for the effectiveness of acupuncture for treating uterine fibroids. Moreover, there are numerous evidence based and useful options for treating this condition, so using acupuncture may actually provide you with worse result.
- Acupuncture for irritable bowel syndrome (IBS) – Another meta review from Cochrane has found that acupuncture has no significant effect on IBS global symptoms, pain and quality of life compared with placebo.
- Acupuncture for otitis media with effusion (fluid in the middle ear) – A common condition for children, which acupuncturists enjoy trying to “fix.” However, according to the Medical Journal of Australia article, “no evidence was found investigating the use of acupuncture for treating otitis media (OME), therefore (it is recommended) that acupuncture should not be used for the management of patient with OME.”
- Acupuncture for lower urinary tract symptoms in men – “The absence of data from studies makes it impossible to determine either benefits or harms from acupuncture or homeopathy in this population, therefore (it is recommended) that acupuncture should not be used for treating lower urinary tract symptoms in men.”
- Acupuncture to treat hyperbilirubinemia (jaundice) – The study concluded starkly that “there is no evidence to support the use of acupuncture to treat hyperbilirubinaemia–NICE (the Australian National Institute for Health an dClinical Excellence) recommends that this treatment not be used in this population.”
- Laser acupuncture for carpal tunnel syndrome – A systematic review showed that there is “insufficient evidence to support the use of laser acupuncture for the treatment of CTS in adults.”
- Acupuncture for depression – A systematic review of systematic reviews concluded that, “…the effectiveness of acupuncture as a treatment of depression remains unproven and the authors’ findings are consistent with acupuncture effects in depression being indistinguishable from placebo effects.” Another systematic review has shown that there is no clinical evidence for treating depression in over 2800 study participants, concluding that “we found insufficient evidence to recommend the use of acupuncture for people with depression.”
- Acupuncture for osteoarthritis – Another systematic review from Cochrane shows that controlled trials show statistically significant benefits. However, the improvement is so small that it does reach the thresholds for clinical relevance, an important factor in evidence based medicine. Moreover, because these studies have weak to incomplete blinding, many of the results can be, at least partially, attributed to the placebo effect.
- Acupuncture for Bell’s palsy – Another one of those weasel worded Cochrane studies states that “the quality of the included trials was inadequate to allow any conclusion about the efficacy of acupuncture.” In other words, no evidence for acupuncture having a meaningful effect on Bell’s palsy.
There are many other areas where there is simply acupuncture research has provided no evidence supporting its use in any medical condition. Back pain? No. Migraine? No, if you critically examine the literature. Infant colic? Setting aside the disgust I have for anyone subjecting their baby to needles, it doesn’t work. Knee pain? Again, nope.
The TL;DR version
By almost any definition, acupuncture is a pseudoscience. Acupuncture relies upon concepts that defy plausible biological or physiological understanding of the human body. The wide breadth of scientific literature on acupuncture research provides us with badly designed studies, that show little evidence beyond a placebo effect generally without any known clinical benefit.
I’m guessing we waste more money on acupuncture research than almost any other field of pseudoscience. And all we’ve found is nothing.
- Cochrane reviews of many medical procedures have annoying weasel-worded conclusions such as “the evidence was inconclusive whether acupuncture was better than the control.” It’s a logical fallacy, Argument from Ignorance, which states that if you have no evidence to support the claim, there still might be evidence to support it if you look hard enough. That doesn’t fly. These high quality meta reviews almost always show that there is no evidence that acupuncture works. And that’s why they form what is called evidence based medicine.
- Ahn AC, Colbert AP, Anderson BJ, Martinsen OG, Hammerschlag R, Cina S, Wayne PM, Langevin HM. Electrical properties of acupuncture points and meridians: a systematic review. Bioelectromagnetics. 2008 May;29(4):245-56. doi: 10.1002/bem.20403. Review. PubMed PMID: 18240287.
- Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust. 2012 Nov 19;197(10):556-60. PubMed PMID: 23163685.
- Ernst E. Acupuncture–a critical analysis. J Intern Med. 2006 Feb;259(2):125-37. Review. PubMed PMID: 16420542.
- Ernst E, Lee MS, Choi TY. Acupuncture for depression?: A systematic review of systematic reviews. Eval Health Prof. 2011 Dec;34(4):403-12. doi: 10.1177/0163278710386109. Epub 2010 Dec 7. Review. PubMed PMID: 21138913
- Goodyear-Smith F, Arroll B. What can family physicians offer patients with carpal tunnel syndrome other than surgery? A systematic review of nonsurgical management. Ann Fam Med. 2004 May-Jun;2(3):267-73. Review. PubMed PMID: 15209206; PubMed Central PMCID: PMC1466671.
- He L, Zhou MK, Zhou D, Wu B, Li N, Kong SY, Zhang DP, Li QF, Yang J, Zhang X. Acupuncture for Bell’s palsy. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD002914. Review. Update in: Cochrane Database Syst Rev. 2010;(8):CD002914. PubMed PMID: 17943775.
- Lim B, Manheimer E, Lao L, Ziea E, Wisniewski J, Liu J, Berman B. Acupuncture for treatment of irritable bowel syndrome.Cochrane Database Syst Rev. 2006 Oct 18;(4):CD005111. Review. Update in: Cochrane Database Syst Rev. 2012;5:CD005111. PubMed PMID: 17054239.
- Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DA, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD001977. doi: 10.1002/14651858.CD001977.pub2. Review. PubMed PMID: 20091527; PubMed Central PMCID: PMC3169099.
- Smith CA, Hay PP, Macpherson H. Acupuncture for depression. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD004046. doi: 10.1002/14651858.CD004046.pub3. Review. PubMed PMID: 20091556.
- Smith CA, Crowther CA, Grant SJ. Acupuncture for induction of labour. Cochrane Database Syst Rev. 2013 Aug 15;(8):CD002962. doi: 10.1002/14651858.CD002962.pub3. Review. PubMed PMID: 23945980.
- Zhang Y, Peng W, Clarke J, Liu Z. Acupuncture for uterine fibroids. Cochrane Database Syst Rev. 2010 Jan 20;(1):CD007221. doi: 10.1002/14651858.CD007221.pub2. Review. PubMed PMID: 20091625.
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