| When people discover that I'm studying acupuncture | | | | and other medical professionals will base their opinion |
| a common question I get asked is "isn't acupuncture | | | | on acupunctures effectiveness based on these |
| just placebo?" The short answer is yes and no. I | | | | results. These results will also be used by newspapers |
| have written this article in response to this question | | | | so they have a huge impact on public opinion. |
| and to examine the placebo effect. I have tried to | | | | Acupuncture is considered to be a holistic medicine |
| be as objective as possible but obviously my view is | | | | which treats the whole person. As a result it takes |
| going to be biased as I am studying to become an | | | | into account many signs, factors and observations |
| acupuncturist so I obviously think it is more than | | | | that are considered irrelevant in western medicine. |
| placebo. | | | | Any treatment with acupuncture is therefore based |
| To start with the definition of the placebo effect is | | | | on individual symptoms so there is no treatment |
| "A substance containing no medication and prescribed | | | | protocol for one particular disease. For example when |
| or given to reinforce a patient's expectation to get | | | | performing a trial on the effectiveness of |
| well." Broadly speaking placebo is an effective | | | | acupuncture for back pain the trial is riddled with |
| treatment that is present in all therapies. The | | | | problems from the start whether it is investigating |
| similarities in all therapeutic relationships are that a | | | | the effectiveness of acupuncture, osteopathy or any |
| person goes to a medical authority, they air they | | | | other intervention. Chaitow a prominent osteopath |
| complaint, receive reassurance in most circumstances | | | | comments on the problems encountered when |
| and receive treatment of some description. This | | | | performing clinical trials on back pain. |
| process alone is a placebo effect. Trust and the | | | | "Acute back pain' may have a wide variety of |
| relationship between practitioner and the patient is a | | | | causes, ranging from biomechanical to pathological, |
| huge element. The bedside manner is hugely | | | | psychological and functional, possibly involving |
| important as rapport in itself will have a positive | | | | intervertebral disc problems, facet joint dysfunction, |
| impact on the patient. Then there is the expectation | | | | hypermobility, muscular and/or ligamentous |
| of the treatment, the higher the expectation the | | | | imbalances, sacro-iliac restrictions, trigger points and |
| greater effect. | | | | disturbed emotion/ somatisation (among others), |
| One other important factor in increasing the placebo | | | | making it a virtual certainty that 'acute back pain' will |
| effect is ritual. The greater the ritual the greater the | | | | not respond to a single intervention, whether HVLA |
| placebo effect is. Acupuncture does have a large | | | | manipulation or anything else." |
| ritual in terms of the initial consultation, examination | | | | This is a huge obstacle in the promotion of |
| and treatment so therefore is considered to have a | | | | acupuncture as clinical trials are used to determine |
| large placebo effect. | | | | effectiveness of such treatments. There are many |
| Many people do not realize that placebo effect is | | | | more trials being conducted on the use of |
| present in all medicine. | | | | acupuncture all of which have had various outcomes |
| One such story below gives a fascinating account of | | | | some positive and some negative. There are many |
| how placebo can be performed in surgery. | | | | more problems with conducting clinical trials for |
| "Forty years ago, a young Seattle cardiologist named | | | | acupuncture and is a huge topic. The Holy Grail for |
| Leonard Cobb conducted a unique trial of a | | | | acupuncturists at the moment is finding a way of |
| procedure then commonly used for angina, in which | | | | putting acupuncture through clinical trials that satisfy |
| doctors made small incisions in the chest and tied | | | | both acupuncturists and the medical community. |
| knots in two arteries to try to increase blood flow to | | | | East meets West a clash of cultures |
| the heart. It was a popular technique-90 percent of | | | | One must understand how acupuncture was born in |
| patients reported that it helped-but when Cobb | | | | order to understand. Acupuncture is a system that |
| compared it with placebo surgery in which he made | | | | was created before the advent of clinical trials and |
| incisions but did not tie off the arteries, the sham | | | | imaging techniques. The concept of an energy |
| operations proved just as successful. The procedure, | | | | system is not unique to acupuncture or to china and |
| known as internal mammary ligation, was soon | | | | can be found where intuition and observation were |
| abandoned ("The Placebo Prescription" by Margaret | | | | the only tools available. In India for example qi is |
| Talbot, New York Times Magazine, January 9, | | | | called prana and they have a very similar healing |
| 2000).*" | | | | system. |
| You can't obviously prescribe placebo surgery for | | | | The origins of acupuncture are somewhat unclear but |
| obvious ethical reasons but this demonstrates both | | | | I will offer some views that may enlighten the |
| placebo and the power of ritual quite nicely. | | | | reader. Chinese culture has a long tradition of martial |
| There are other factors involved in placebo effect | | | | arts and mediation practice stemming from religious |
| that are not directly concerned with acupuncture but | | | | traditions such as Buddhism and Daoism. Through |
| interesting none the less. For example red pills are | | | | these techniques a quietening of the mind occurs and |
| more effective than blue ones. Four pills are more | | | | practitioners become aware of subtle feelings in the |
| effective then two. There is great deal more to the | | | | body. Through these observations the energy |
| placebo effect and I suggest you read Ben Goldacres | | | | system of the body were mapped. |
| book "Bad Science" if this interests you. | | | | In fact it's not particularly difficult to feel this energy |
| Acupuncture is also used on animals for muscular | | | | just sign up to your local tai chi class for 6 months. |
| skeletal problems and arthritis mainly. Again the | | | | This is further illustrated in China's early history. China |
| positive results seen in animals have been contributed | | | | for a long time did not perform autopsies because |
| to the placebo effect. The theory goes that even | | | | they saw no point in studying something that had no |
| animals benefit from acupuncture because their | | | | life in it. How the use of fine needles originated is still |
| guardians or owners have been influenced by the | | | | somewhat unclear but pressing and rubbing on |
| placebo effect. | | | | various points to relieve symptom was in use for |
| Current understanding of Acupuncture | | | | some time and acupuncture is an extension of this |
| To start with a definition of acupuncture is needed. | | | | practice. |
| "According to traditional Chinese philosophy, our | | | | As westerners we have extremely analytical minds |
| health is dependent on the body's motivating energy | | | | and we are educated to reason and analyse through |
| - known as qi - moving in a smooth and balanced | | | | the use of logic. Intuition and feeling are not valued |
| way through a series of meridians (channels) beneath | | | | highly and few roles utilise these skills. It is very hard |
| the skin. The flow of qi can be disturbed by many | | | | to convince someone in the west that acupuncture |
| factors, physical, mental and emotional: anxiety, | | | | exists without data to back it up and as previously |
| stress, anger, fear or grief, poor nutrition, weather | | | | stated clinical trials involving acupuncture are fraught |
| conditions, hereditary factors, infections, poisons and | | | | with problems. For the acupuncturist the reverse is |
| trauma. By inserting fine needles into the channels of | | | | true placing a great deal on training of the senses so |
| energy, an acupuncturist can stimulate the body's | | | | are frustrated with such a great emphasis based on |
| own healing response and help to restore its natural | | | | clinical trials which are limited in there scope of |
| balance." | | | | understanding and recording the benefits of |
| British Acupuncture Council | | | | acupuncture. The benefits of acupuncture will often |
| Acupuncture is often accredited with purely just | | | | extend into all levels of ones life both physical and |
| being placebo effect because modern science as yet | | | | emotional. |
| doesn't understand the process involved upon which | | | | Conclusion |
| the theory is based. In acupuncture's case this is the | | | | You could conclude then that yes acupuncture does |
| understanding of energy which flows through | | | | have a placebo effect and because western medicine |
| meridians/channels throughout the body. This is | | | | can not attribute the data to the effect of qi that |
| where the two worlds collide as Bausell states | | | | acupuncturists claim then the positive effect can only |
| (page275). "No CAM therapy has a scientifically | | | | be placebo. |
| plausible biochemical mechanism of action over and | | | | Another conclusion could be again that acupuncture |
| above those proposed for the placebo effect." | | | | does have a placebo effect and that the additional |
| Modern science has further problems with | | | | positive effects are due to an unknown effect. You |
| acupuncture as Bausell (page106) goes onto state | | | | could also conclude that some of the observations |
| "But if the primary biochemical explanation for how | | | | made are correct i.e. that sticking need les into parts |
| these little needles reduce pain involves an | | | | of the body does reduce pain but subscribe to a |
| unmeasurable energy force surging through some | | | | western model of understanding. |
| unobservable meridians with no documented | | | | The goal of medicine is always to preserve health, |
| connection to pain or anything else, then most | | | | prevent disease and treat illness. Although both |
| members of the scientific community will have a | | | | approaches to medicine would agree on these |
| difficult time believing these positive results." | | | | fundamental points they reach them from entirely |
| Presently there are two forms of acupuncture in use | | | | different perspectives. |
| in the uk, traditional acupuncture based on the theory | | | | Personally I know that qi exists from having done qi |
| of qi or energy as used in China, Japan and Korea | | | | gong for a number of years and have felt the |
| and medical acupuncture often referred to as dry | | | | sensation of qi moving through the channels in my |
| needling as practised by doctors, physiotherapists and | | | | body. Other students can perceive this energy too. |
| other primary care physical therapists. Acupuncture | | | | When I have acupuncture I also feel this same |
| has been reinterpreted by the west as Campbell | | | | sensation. My old qi gong teacher practiced a form of |
| clarifies | | | | qi gong known as hard qi gong which is used to |
| "In practice, sticking needles into people often does | | | | condition the body. When the body is conditioned |
| relieve symptoms, especially (but not exclusively) | | | | you can perform unimaginable feats such as bending |
| pain. Largely for this reason, acupuncture has been | | | | spears on your throat and having bricks broken on |
| taken up by a number of health professionals in the | | | | your head, you may of seen such displays performed |
| West, many of whom have reinterpreted it in terms | | | | by the Shoalin monks. They are all using their qi. |
| of modern anatomy, physiology, and pathology. This | | | | There are also stories of great masters of |
| form of acupuncture has been called Western | | | | acupuncture diagnosing patients simply by looking at |
| medical acupuncture or dry needling. People who | | | | them and telling them in great detail about their |
| practise in this way accept that the ancient Chinese | | | | personnel life and there present condition. I have also |
| made many correct observations but do not see the | | | | seen the great benefit acupuncture has had from my |
| need to follow them in the theory that they erected | | | | time doing clinical observations with practitioners |
| on these observations. Modernists therefore ignore, | | | | which has ranged form hyperactive 2 year old |
| partially or completely, the traditional apparatus of | | | | through to arthritic 80 year olds with disc |
| "meridians", "acupuncture points", yin and yang and so | | | | degeneration. |
| forth and use different criteria in deciding where and | | | | Qi or energy may not ever yield to scientific |
| how to insert the needles. " | | | | instrumentation but it easily recognizable only by living |
| Problems with clinical trials | | | | beings. There are many mysteries in the world that |
| Currently there is a great deal of interest into | | | | science has yet to solve and acupuncture may be |
| acupuncture which has resulted in numerous clinical | | | | one of them. |
| trials researching the effects acupuncture. Doctors | | | | |