Trick or Treatment—The Undeniable Facts about Alternative Medicine (Electronic book text)

Placebo control groups are easy to arrange in the context of conventional drug trials, because the treatment group can, say, receive a pill with the active ingredient and the placebo control group can receive an identical-looking pill without the active ingredient. Or the treatment group can receive an injection of the active drug and the placebo control group can receive an injection of saline. Unfortunately, there was no similarly obvious placebo replacement for acupuncture.

Gradually, however, researchers began to realize that there were two ways of making patients believe that they were receiving real acupuncture, when they were in fact receiving fake acupuncture. One option was to needle patients to only a minimal depth, as opposed to the centimetre or more that most practitioners would use. The purpose of this superficial needling was that it seemed like the real thing to patients who had not previously experienced genuine acupuncture, but according to the Chinese theory it should have no medical benefit because the needles would not reach the meridian. Therefore researchers proposed studies in which a control group would receive superficial needling, while a treatment group would receive real acupuncture. Both groups would receive similar levels of placebo benefit, but if real acupuncture has a real physiological effect then the treatment group should receive a significant extra benefit beyond that received by the control group.

Another attempt at placebo acupuncture involved needling at points that are not acupuncture points. Such points traditionally have nothing to do with a patient’s health. This misplaced needling would seem like genuine acupuncture to new patients, but according to the Chinese theory misplaced needling should have no medical benefit because it would miss the meridians. Hence, some trials were planned in which the control group would receive misplaced needling and the treatment group would receive genuine acupuncture. Both groups would receive the benefit of the placebo effect, but any extra improvement in the treatment group could then be attributed to acupuncture.

These two forms of placebo acupuncture, misplaced and superficial, are often termed sham needling. During the 1990s, sceptics pushed for a major reassessment of acupuncture, this time with placebo-controlled clinical trials involving sham needling. For many acupuncturists, such research was redundant because they had seen how their own patients had responded so positively. They argued that the evidence in favour of their treatment was already compelling. When critics continued to demand placebo-controlled trials, the acupuncturists accused them of clutching at straws and of being prejudiced against alternative medicine. Nevertheless, those medical researchers who believed in the authority of the placebo-controlled trial refused to back down. They continued to voice their doubt and argued that acupuncture would remain a dubious therapy until it had proved itself in high-quality clinical trials.

Those demanding proper acupuncture trials eventually had their wish granted when major funding enabled dozens of placebo-controlled clinical trials to take place in Europe and America throughout the 1990s. Each trial was to be conducted rigorously in the hope that the results would shed new light on who was right and who was wrong. Was acupuncture a miracle medicine that could treat everything from colour blindness to whooping cough, or was it nothing more than a placebo?

Acupuncture on trial

By the end of the twentieth century a new batch of results began to emerge from the latest clinical trials on acupuncture. In general these trials were of higher quality than earlier trials, and some of them examined the impact of acupuncture on conditions that had not previously been tested. With so much new information, the WHO decided that it would take up the challenge of summarizing all the research and presenting some conclusions.

Of course, the WHO had already published a summary document in 1979, which had been very positive about acupuncture’s ability to treat more than twenty conditions, but they were keen to revisit the situation in light of the new data that was emerging. The WHO team eventually took into consideration the results from 293 research papers and published their conclusions in 2003 in a report entitled Acupuncture: Review and analysis of reports on controlled clinical trials. The new report assessed the amount and quality of evidence to support the use of acupuncture for a whole series of conditions, and it summarized its conclusions by dividing diseases and disorders into four categories. The first category contained conditions for which there was the most convincing evidence in favour of using acupuncture and the fourth contained conditions for which the evidence was least convincing: