Acupuncture

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Here in British Columbia, our provincial medical services plan subsidizes acupuncture treatments with public funds, and acupuncture is a designated health profession. My student medical plan offers me subsidized acupuncture treatments, and there's a temporary acupuncture clinic on my university campus. According to Google maps, there are fifteen acupuncture clinics operating within five blocks of my apartment here in downtown Victoria, including at least two acupuncture colleges whose students qualify for government loans. Very many of my peers have expressed great faith in acupuncture, and a few are aspiring acupuncturists.

In other words, my community has granted acupuncture mainstream acceptance.

This fact has piqued my interest as taxpayer, a community member, as a student of biology, and as a nerdy science blogger. So recently, I went around to seven different acupuncture schools and clinics in my neighborhood, collecting brochures, and pressing the staff on a couple key points; and following, I have attempted a fair but meaningful criticism of the answers these questions received.

"What is acupuncture?"

The brochures I collected offer understandably broad definitions of "acupuncture":

"Acupuncture is based on the recognition of a system of energetic pathways in the body called meridians. Meridians connect the body's surface to the internal organs and contain energy called Qi ... by inserting special needles at specific points on the meridians, acupuncture can correct energetic imbalances or blockages, which may be the cause of distress."(1)

"Acupuncture is the insertion of fine needles into the body at specific points shown to be effective in the treatment of specific health problems."(1)

"An acupuncturist will place fine, sterile needles at specific acupoints on the body. This activates the body's Qi and promotes natural healing..."(2)

But as their authors might agree, "acupuncture" can vary. Sometimes the needles are gently manipulated after insertion and other times they are not. In some cases they are heated, or charged with electricity. Some acupuncturists use lasers. Many acupuncturists augment their treatments with prescriptions of various herbs or creams, with "moxibustion" (the burning of mugwort to 'warm' acupoints), massage, acupressure, or "cupping" (the placement of suction cups on the skin). And diverse systems such as traditional Chinese acupuncture (which views the tongue as a kind of map of the body), Korean hand acupuncture (which views the hand as a map of the body), and auricular acupuncture (which is largely French in origin, and which views the ear as a map of the body) are all huddled together beneath this linguistic umbrella.

(As an interesting side note: it is a basic precept of reflexology that the foot is a map of the body; and of iridology that the iris is a map of the body.)

To it's credit, one brochure explicitly acknowledges this, advising patients:

"in different countries, different styles [of acupuncture] have developed based on differing opinions as to theory and technique ... learn as much as much as possible about the treatment being proposed."(1)

"What can acupuncture do for me?"

The diversity of word "acupuncture" turns out to be of direct relevance to my community, because a few of my local clinics advertise examples from a list of health conditions for which the World Health Organization (WHO) has endorsed it. This is a truly extensive list, and includes afflictions as diverse as anxiety, arthritis, colds and flus, dysentery, hiccups ("hiccough"), pain of all kinds, pneumonia, smoking addiction, and urinary tract infections. Make no mistake: the WHO endorsement of "acupuncture" for so many different reasons is an extremely impressive indication of acupuncture's overall effectiveness.

Or at least it would have been impressive if I had never heard of the internet. Upon locating the WHO list on-line however (here's the complete list) I discovered that it employed an extremely vague definition of "acupuncture":

"In this publication the term 'acupuncture' is used in its broad sense to include traditional body needling, moxibustion, electric acupuncture, laser acupuncture, microsystem acupuncture such as ear (auricular), face, hand, and scalp acupuncture, and acupressure."

This is significant, because it means that the WHO endorsements are based on a collection studies that actually examined very dissimilar procedures. This in turn seems to mean that acupuncture clinics in my community are promoting their services based on the outcome of studies that did not necessarily involve the specific procedures they are offering. As just one example of the kind of ethical concerns this raises: "electro-acupuncture" is virtually identical to a conventional procedure (known as TENS) that is actually used to treat some of the WHO-endorsed conditions (osteoarthritis, various kinds of pain) - and yet neither of these two clinics appeared to be offering electro-acupuncture.

But the WHO endorsements were presented as being merely examples of the kinds of complaints that "acupuncture" can address; and in addition I also collected brochures advertising a treatment for

AIDS, anemia, attention deficit, cancer, carpel tunnel, "computer syndromes", Crohn's disease, deafness, diabetes, ear ringing, epilepsy, emotional problems, eye problems, heart disease, hepatitis, herpes, "insufficient milk", kidney disorders, liver disorders, lupus, menopause, mental retardation, menstrual disorders, "neuroasthenia" (possibly an imaginary disease), pinworm infection, parkinsens [sic], reproductive problems, shingles, stroke, tuberculosis, thyroiditis, and yeast infections.(2)(3)

Until very recently, acupuncture was also being solicited in my neighborhood for "body-shaping" purposes; and one of my brochures states that

"even after your symptoms have resolved, acupuncture can help you in maintaining your health, and possibly prevent future imbalances." (5)(4)

Indeed, when I inquired as to whether I could benefit from acupuncture despite lacking any specific complaint, staff at a local college responded confidently in the affirmative.

"How does acupuncture work?"

Too sexy for his meridians

I invariably received a reply to this question that prominently featured the words "qi", "meridians", and "acupoints". Only one practitioner mentioned "chakras" in lieu of prompting.

In fact, it appears that many of their advertised services utterly depend on the existence of these (or similar) phenomena. For example, qi and meridians underpin the incredible versatility they ascribe themselves by implying that very dissimilar complaints can have a common "root cause" and thus can be treated in a similar way. And their presumed existence allows acupuncturists to solicit, not mere relief, but a potentially profound and lasting cure as indeed many of them clearly are:

"Not only can acupuncture treat signs and symptoms of pain and discomfort, it can also get to the root cause of the problem."(4)

"Your [acupuncturist] will ... preform a physical exam to determine how and why your body's vital energy, or qi, is out of balance, and what the root causes are contributing to the overall problem."(4)

"All activities, both physical and mental, are manifestations of Qi. The body is woven together and interconnected by a network of meridians through which the Qi and blood flow ... By inserting special needles at specific points on the meridians, acupuncture can correct energetic imbalances or blockages, which may be the cause of distress."(1)

But despite their being of obvious interest to acupuncture practitioners, students, and patients (or to anyone with a passing interest in human health, or indeed in anything remotely biological in nature), my brochures also inform me that 

"modern Western medicine cannot explain how acupuncture works",

and claim that these 

"energies and substances [are] unfamiliar to the West".(1) 

I can see how this might have seemed convincing in the 1970s or 80s, but it seems to ring pretty hollow today, now that acupuncture has been a designated health profession here in "the West" for the last 15 years. Given that their services and teachings are fundamentally predicated on a decent understanding of these "energies and substances", this kind of arcane language seems inexcusable to me.

For one thing, it seems that even the "East" is grappling with the concepts of qi and meridians: according to this official account, although Chinese scientists recently used their country's "most expensive ever science project" to try and "solve the mystery of acupuncture points" in the end they could only announced having found a "gathering of micro-vessels" - certainly a remarkable manifestation of "the body's vital energy". In fact, if this is the best the "East" can do they might be interested in my "Western" brochures, since one of them claims that:

"recently, electromagnetic research has confirmed [acupoints] locations",(1) 

and another offers a

"computerized meridian analysis and diagnosis".(3)

For another thing, acupuncture has been extensively studied here in "the West", although it is true that this has not been easy. Indeed, it seems to have been the subject of many hundreds of studies; and many of these do propose an alternative mechanism by which acupuncture might be "explained". It's called "the placebo effect" - a conclusion that severely undercuts acupuncturists claimed access to a "Western"-neglected root cause of all illness.

(Click here to have "modern Western medicine" "explain" acupuncture.)

The notion that acupuncture works due to the manipulation of qi, on the other hand, conflicts not just with "Western medicine" but also with basic science: for example, the germ theory of disease and the theory of evolution (make no mistake: the central unifying concept of modern biology would face a serious reassessment in light of such a fundamental "life force"). It seems that my local acupuncturists are actually saying is that "our claims are based on phenomena for which modern biology does not account". Unfortunately, it is hard for me to picture the market failing to punish them for rising to this level of honesty: language frames thinking, and acupuncturists are well advised to contrast themselves with "Western medicine" as opposed to "basic biology".

"How old is acupuncture?"

To be honest, I didn't ask anyone this question on my neighborhood acupuncture tour. But neither did I have to: almost without fail I was told that acupuncture is an "ancient" practice. This didn't impress me with my local acupuncturists profound respect for the history of their discipline, however, because I was told that acupuncture is 2000, 3000, and 5000 years old. To be fair, online sources exist for all three estimates.

This claim of ancientness has value to any acupuncturists seeking to attract patients (or students), because it clearly suggests that the procedures being offered are effectively the same as those offered by acupuncturists thousands of years ago. It portrays a thoroughly time-tested Chinese folk remedy that has been gradually perfected by untold generations of trial and error. And in the minds of many, this claim endows a credibility that no scientific study could ever hope to match - or to undo.

However, as previously noted, today these allegedly "ancient" procedures often incorporate technologies that are clearly endemic to the industrial era, such as electricity and lasers. Indeed, it turns out that even acupuncturist's most common tool - the stainless steel needle - is only about a hundred years old. Considering this, it's almost comical that one of my brochures states:

"Acupuncture is an ancient Chinese medical procedure that involves the insertions and manipulation of sterilized stainless-steel needles in the body."(3)

This is a nontrivial point, because stainless steel can be fashioned into extremely fine, strong, and flexible needles; and any acupuncture that occurred in ancient history probably bore precious little resemblance to its contemporary descendant. In fact, a glance at some old school "acupuncture" needles has convinced me that it's very unlikely ancient Chinese peasants were lining up in droves to have their dizziness, fatigue, emotional problems, or hiccups addressed by this method. And trust me, I've had the goddamn hiccups.

Some ancient "acu"puncture needles...

...versus the modern variety.

It is even less likely that ancient acupuncturists ever addressed obesity, cigarette addictions, or street drug highs as they do in my community today. In fact, as far ancient history is concerned, the vast majority of services my neighborhood acupuncturists are offering are thoroughly untested.

It certainly seems to be true that modern acupuncture is based on concepts that are thousands of years old, but this is a very different claim. After all, surgeons do not suggest that experimental procedures are time-tested simply because a recognition of flesh and bone extends into antiquity.

In reality, it appears that "acupuncture" is a diffuse, modern, and fairly "Westernized" offshoot of a much broader school of medicine popularly known today as "Traditional Chinese Medicine" (TCM); and acupuncturists claims of ancientness seem to jar with the fact that the Traditional Chinese Medicine Association of British Columbia actually opposed the official designation of acupuncture as a health profession, on the grounds that acupuncture is

"only one part of the more broadly based practice of traditional Chinese medicine"  

*  *  *

Everyone I spoke to on my little neighborhood "acu-tour" was extremely friendly, and willingly answered all my annoying questions. I was showered with brochures and enthusiastically lectured on the principles of acupuncture. To be clear: every acupuncturist or staff member I spoke to appeared entirely compassionate, sincere, and intelligent.

Nonetheless, it seems to me that acupuncturists in my community are a) claiming to offer a profound and versatile healing service despite good scientific evidence to the contrary; b) soliciting their services in the name of misappropriated scientific evidence and distorted historical fact; and c) promoting and teaching a parallel version of biology for which little evidence exists. And in my opinion, by doing so they risk causing their patients to misdirect their resources, or to take unnecessary risks (after all acupuncture is certainly not risk-free), and they risk misleading our youth and thus impoverishing our culture (not unlike the teaching of "intelligent design" or an altered version of history).

(As if it weren't bad enough that I'm helping to bankroll these endeavors with my tax dollars, a CBC news investigation recently highlighted another example of the dangers inherent in subsidizing such an ill-defined and pseudo-scientific treatment.)

Of course, it is always possible that acupuncture is the future; that these people will help lead us all into a better, healthier, and more enlightened tomorrow. But it seems clear that the road there is paved entirely with their good intentions.

Cited brochures were obtained from:

1. Canadian College of Acupuncture and Oriental Medicine
2. Dr. Pan's Clinic of Traditional Chinese Medicine
3. International College of Traditional Chinese Medicine
4. Metro Massage Therapy and Acupuncture Clinic
5. Sapphire Day Spa

I also visited and spoke to staff at:

• Awakening Wellness Center
• Pacific Rim College of Complementary and Integrative Medicine