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

The research is so poor and so minimal that the Cochrane Collaboration has not even bothered conducting a systematic review.

Moreover, systematic reviews by other institutions and universities come to exactly the same sort of conclusions arrived at by the Cochrane Collaboration. Despite the fact that there is no reason to believe that it works for any of these conditions, except as a placebo, thousands of clinics in Europe and America are still willing to promote acupuncture for such a wide-ranging list of ailments.

The good news for acupuncturists is that the Cochrane reviews have been more positive about acupuncture’s ability to treat other conditions. There have been cautiously optimistic Cochrane reviews on the treatment of pelvic and back pain during pregnancy, low back pain, headaches, post-operative nausea and vomiting, chemotherapy-induced nausea and vomiting, neck disorders and bedwetting. Aside from bedwetting, the only positive conclusions relate to acupuncture in dealing with some types of pain and nausea.

Although these particular Cochrane reviews are the most positive about acupuncture’s benefits, it is important to note that their support is only half-hearted. For example, in the case of idiopathic headaches, namely those that occur for no known reason, the review states: ‘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.’

Because the evidence is only marginally positive and not fully convincing, even in the areas of pain and nausea, researchers have focused their efforts on improving the quality and amount of evidence in order to reach a more concrete conclusion. Indeed, one of the authors of this book, Professor Edzard Ernst, has been part of this effort. Ernst, who leads the Complementary Medicine Research Group at the University of Exeter, became interested in acupuncture when he learned about it at medical school. Since then, he has visited acupuncturists in China, conducted ten of his own clinical trials, published more than forty reviews examining other acupuncture trials, written a book on the subject and currently sits on the editorial board of several acupuncture journals. This demonstrates his commitment to investigating with an open mind the value of this form of treatment, while thinking critically and helping to improve the quality of acupuncture trials.

One of Ernst’s most important contributions to improving the quality of trials has been to develop a superior form of sham acupuncture, something even better than misplaced or superficial needling. Figure 1 on page 45 shows how an acupuncture device consists of a very fine needle and a broader upper part that is held by the acupuncturist. Ernst and his colleagues proposed the idea of a telescopic needle — that is, an acupuncture needle that looks as if it penetrates the skin, but which instead retracts into the upper handle part, rather like a theatrical dagger.

Jongbae Park, a Korean PhD student in Ernst’s group, went ahead and built a prototype, overcoming various problems along the way. For example, usually an acupuncture needle stays in place because it is embedded in the skin, but the telescopic needle would only appear to penetrate the skin, so how would it stay upright? The solution was to rely on the plastic guide tube, which acupuncturists often use to help position and ease needle insertion. The guide tube is usually removed after insertion, but Park suggested making one end of the tube sticky and leaving it in place so that it could support the needle. Park also designed the telescopic system so that the needle offered some resistance as it retracted into the upper handle. This meant that it would cause some minor sensation during its apparent insertion, which in turn would help convince the patient that this was real acupuncture that was being practised.

When the Exeter group tested these telescopic needles as part of a placebo acupuncture session, patients were indeed convinced that they were receiving real treatment. They saw the long needle, watched it shorten on impact with the skin, felt a small, localized pain and saw the needle sitting in place for several minutes before being withdrawn. Superficial and misplaced needling were adequate placebos, but an ideal acupuncture placebo should not pierce the skin, which is why this telescopic needling was a superior form of sham therapy. The team was delighted to have developed and validated the first true placebo for acupuncture trials, though their pride was tempered when they discovered that two German research groups at Heidelberg and Hannover Universities had been working on a very similar idea. Great minds were thinking alike.