The rat didn’t squirm much as the needles were carefully inserted. There was no pain. Stopwatch in hand, the researcher then focused a heat gun on the animal’s rear and carefully noted the time required for the tail to “flick” by reflex action. Other rats, some needled and some not, were also subjected to the same procedure. The conclusion was that acupuncture significantly delayed the onset of pain!
Proponents of acupuncture often quote this study as proof that the 2,000-year-old Chinese technique of jabbing needles into the body to treat medical conditions has a scientific basis. After all, they claim, the effect cannot be in the rats’ minds, as they have none! But a rat is not a miniature person. So what’s the story about acupuncture for humans? Let’s take a stab at that question. We’ll begin with a bit of history.
The Western world was alerted to the practice of acupuncture in 1972, when Richard Nixon visited China. A New York Times reporter who accompanied the president had to undergo an emergency appendectomy, and received acupuncture therapy for postoperative pain. He was so impressed by the unusual nature of this treatment that he related his experience in the Times. The story then took on a life of its own, and rumors mounted upon rumors.
“Did you hear about the guy who had his appendix removed in China without any anesthetic?” buzzed the incredulous. “Those clever Chinese just stuck a few needles into him, and he felt nothing!” But the truth was that the surgery had been carried out with regular anesthesia, and acupuncture had only been used in an attempt to dull the reporter’s pain after the operation. Nevertheless, the appetite of the American public had been whetted by the notion of such an apparently simple solution to the problem of pain. The government assembled an Acupuncture Study Group, composed of many notable physicians and researchers, to study the Chinese experience with the technique. In 1974, off they went to the mysterious East to learn how to rid American pain sufferers of their reliance on painkilling medications.
What they found in China did not exactly live up to the advance billing. Acupuncture, as it turned out, was not widely used as an anesthetic procedure. Even when it was used, it was almost always in combination with barbiturate-type sedatives and the painkiller Demerol. The glorification of acupuncture, it seems, was based less on science and more on Maoist propaganda designed to fuel the Cultural Revolution and justify a reduced reliance on Western medicine.
The American doctors investigating the Chinese accounts discovered that the claimed benefits for acupuncture were highly suspect. Parkinson’s patients who were being rehabilitated with acupuncture showed no objective improvement. Neither did patients being treated for deafness or head injuries. But just the fact that American physicians were seriously examining acupuncture caused a flurry of interest back home, and soon half-baked acupuncturists were cropping up in every corner, to treat every conceivable disease. The zanier ones were “curing” conditions ranging from multiple-chemical sensitivity in humans to listlessness in goldfish and neuroses in birds. The most amusing spinoff was “earth acupuncture,” which involves hammering wooden stakes into the ground to make the soil more fertile by “altering the earth’s natural flow of energy.” I think the only fertile thing here is the imagination of the proponents of “earth acupuncture.” And this brings up an interesting question. What role does the imagination play in the use of acupuncture to treat disease?
According to the traditional Chinese view, the mind is not involved. Health is based upon yin and yang, opposite forces in the body that must be in balance to maintain health. When yin-yang disharmony occurs, balance can be restored by stimulating channels in the body, which are called “meridians” and supposedly serve as energy conduits to various organs. Acupuncture points are said to lie along these meridians. This explanation, however, cannot be supported by anatomy. There are no identifiable meridians in the human body. Still, the fact that the explanation may be incorrect does not negate the possibility that acupuncture can deliver the goods. The only way to determine if it really works is through controlled studies.
“Placebo control” is the gold standard for modern clinical trials. We know that people respond to sugar pills, and even to fake surgery, roughly 40 percent of the time, a factor that must be taken into account if a study is to be reliable. Designing a placebo-controlled trial of acupuncture, though, presents some obvious problems. What do you use for a placebo? Researchers at Heidelberg University in Germany came up with a very clever idea. They designed a device that could be used in a “sham acupuncture” procedure. Essentially, the idea is modeled on the classic “collapsing knife” effect used on the stage. The blade is gimmicked to retract into the handle as the victim is stabbed, creating the illusion that the knife has plunged into the flesh to the hilt. Similarly, the sham acupuncture device is equipped with a needle that contacts the skin and then moves up into the handle as the device continues its forward motion. It seems as if the needle has been inserted into the skin. Testing on volunteers revealed they did not suspect any absence of actual penetration.
Over 200 women undergoing breast or gynecologic surgery were enrolled in the study, with half receiving the sham treatment, and half having real needles inserted into an acupuncture point on their forearm. Stimulation of this “Pericardium 6” point is traditionally believed to control nausea. Unfortunately, in this experiment, it didn’t. There was no significant difference in postoperative nausea between the two groups, although the patients who had undergone acupuncture did have less of a tendency to vomit. Acupuncturists argue that the results would have been different if several more points had been stimulated. Perhaps.
Since the 1970s, over 500 studies of acupuncture have been published in peer-reviewed scientific journals. Conditions ranging from asthma, drug addiction, and weight reduction to smoking cessation, stroke, and tinnitus (ringing in the ear) have been examined. One would think that so many studies should be able to clarify what acupuncture can and cannot do. Alas, such is not the case. There is much contradictory and inconclusive evidence, as is evident in an excellent recent review published in the Annals of Internal Medicine, a highly respected journal. Ted Kaptchuck of Harvard Medical School surveyed the literature for the best controlled trials, and categorized these in terms of the conditions they attempted to treat and the results they found. Kaptchuk holds a degree in Oriental medicine and uses acupuncture himself, so he certainly is not biased against the technique.
“Good” evidence was found for alleviation of dental pain, reduced vomiting after surgery or chemotherapy, and nausea associated with pregnancy. For chronic pain, headaches, back pain, asthma, and smoking cessation, the evidence was con tradictory, while for addiction and tinnitus it was negative. A British study has shown that weekly acupuncture, in combination with appropriate medication, can do more to reduce the number of days migraine patients suffer a headache than medication alone. How do we explain the contradictory evidence for the treatment of pain? How can it be that some studies show significant positive results but others come up empty? As with other treatments, the expertise of the therapist is undoubtedly important.
Physicians who are trained in acupuncture are the most likely to select the best candidates for treatment, and of course are also adept at diagnosing conditions that require a more orthodox approach. In other words, you have to know when to reach for the antibiotic or the scalpel, and when to reach for the acupuncture needles. The specific nature of the acupuncture technique is also important. Many of the positive results are seen when electrical stimulation is applied through the needles.
Given that acupuncture can in some cases produce positive results, we are saddled with the question of “how?” One explanation involves the body’s production of painkilling substances when stimulated by acupuncture. These “endorphins” are also produced in times of stress, and have been invoked to explain why soldiers often don’t feel their wounds until after the heat of the battle. Some studies have shown that naloxone, a drug that blocks the activity of the endorphins, can also negate the benefits of acupuncture. Professor Ronald Melzack of McGill University, regarded as one of the top experts on pain in the world, points out that acupuncture is not some magical process, but rather just one of many methods that can relieve pain through sensory hyperstimulation. Flood the body with sensory input, he suggests, and there will be pain relief. And I believe him. Many years ago, I had the pleasure of listening to one of Professor Melzack’s lectures in which he described how rubbing an ice cube on the skin between the thumb and forefinger can alleviate a toothache. Hmmmm, skeptical me thought at the time. Then it happened. I woke up one night with a terrible toothache. I took aspirin, I applied oil of cloves to my gums, but nothing helped. Out of desperation, I reached for an ice cube and (feeling somewhat foolish) began to massage my hand. Within minutes, there was blessed relief! Endorphin release? Opening up of “qi” channels? Placebo effect? Who cares! The pain was gone.
The answer to what happened may eventually come from functional magnetic resonance imaging (FMRI) studies of the brain. Scans of this type have already revealed that when subjects’ fingers are immersed in hot water, certain areas of the brain are activated, and that the activity is reduced with acupuncture. But whether the needles are inserted along “meridians,” or elsewhere, seems to make no difference.
What are we to conclude from all this? That acupuncture works in the hands of some practitioners, for some conditions, for some patients, some of the time. This may not sound too optimistic, but the truth is that the same statement can also be made about a number of “orthodox” medical treatments. The best bets for acupuncture seem to be in the areas of dental pain, nausea, and migraine. There may be some help with osteoarthritis, although the benefits fade with time. Risks are minor; they are those associated with any needle use. So, as you can see, the facts don’t pop the acupuncture balloon, but perhaps they do deflate it somewhat.