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

Acupuncturists point out that we cannot simply ignore those randomized placebo-controlled clinical trials that indicate that acupuncture works. Of course, such evidence should not be ignored, but it has to be weighed against the evidence that counters it, and we need to decide which side of the argument is more convincing, much as a jury would do in a legal case. So let us weigh up the evidence. Is acupuncture effective for a wide range of disorders beyond all reasonable doubt? No. Is acupuncture effective for pain and nausea beyond all reasonable doubt? No. Is acupuncture effective for pain and nausea on the balance of probabilities? The jury it still out, but as time has passed and scientific rigour has increased, then the balance of evidence has moved increasingly against acupuncture. For example, as this book goes to print, the results have emerged of a clinical trial involving 640 patients with chronic back pain. According to this piece of research, which was sponsored by the National Institute of Health in America and conducted by Daniel Cherkin, sham acupuncture is just as effective as real acupuncture. This supports the view that acupuncture treatment acts as nothing more than a powerful placebo.

Practitioners argue that acupuncture, like many alternative therapies, is an individualized, complex treatment and therefore is not suitable for the sort of large-scale testing that is involved in a trial. This argument is based on the misunderstanding that clinical trials necessarily disregard individualization or complexity. The truth is that such features can be (and often are) incorporated into the design of clinical trials. Furthermore, most conventional medicine is equally complex and individualized, and yet it has progressed thanks to clinical trials. For instance, a doctor will ask a patient about his or her medical history, age, their general health, any recent changes in diet or routine and so on. Having considered all these factors, the doctor will offer a treatment appropriate to that individual patient — that treatment is likely to have been tested in a randomized clinical trial.

Many acupuncturists claim that the underlying philosophy of their therapy is so at odds with conventional science that the clinical trial is inappropriate for testing its efficacy. But this accusation is irrelevant, because clinical trials have nothing to do with philosophy. Instead, clinical trials are solely concerned with establishing whether or not a treatment works.

Acupuncturists complain that the clinical trial is inappropriate for alternative therapies because the impact of the treatment is very subtle. But if the effect of acupuncture is so subtle that it cannot be detected, then is it really a worthwhile therapy? The modern clinical trial is a highly sophisticated, flexible and sensitive approach to assessing the efficacy of any treatment and it is the best way of detecting even the most subtle effect. It can measure effects in all sorts of ways, ranging from analysing a patient’s blood to asking a patient to assess their own health. Some trials use well-established questionnaires that require patients to report several aspects of their quality of life, such as physical pain, emotional problems and vitality.

Finally, some acupuncturists point out that real acupuncture may perform only as well as sham acupuncture, but what if sham acupuncture offers a genuine medical benefit to patients? We have assumed so far that sham acupuncture is inert, except as a placebo, but is it conceivable that superficial and misplaced needling also somehow tap into the body’s meridians? If this turns out to be true, then the entire philosophy of acupuncture falls apart — inserting a needle anywhere to any depth would have a therapeutic benefit, which seems highly unlikely. Also, the development of the telescopic needle sidesteps this question because it does not puncture the skin, so it cannot possibly tap into any meridians. Acupuncturists might counter by arguing that telescopic needles also offer therapeutic benefit because they apply pressure to the skin, but if this were the case then we would also receive benefits from a handshake, a tap on the back or scratching an ear. Alternatively, such pressure on the skin might sometimes detrimentally influence the flow of Ch’i, so such bodily contact might make us ill.

In short, none of these criticisms stands up to proper scrutiny. They are the sort of flimsy arguments that one might expect from practitioners who instinctively want to protect a therapy in which they have both a professional and an emotional investment. Such acupuncturists are unwilling to accept that the clinical trial is undoubtedly the best method available for minimizing bias. Although never perfect, the clinical trial allows us to get as close to the truth as we possibly can.