The article Puncturing Acupuncture Myths showed up in my feeds. My first thought was really? You had to use puncturing in the title? It is so been there done that. SCAM articles on acupuncture, perhaps by law, need to have point or puncture in the title.
My next thought was the only thing acupuncture will puncture is the occasional lung, although my favorite example is the dry needling video (dry needling is acupuncture without the traditional Chinese pseudo-medicine component). I do not know what gives me the willies more: dropping the lung or the total lack of infection control including the needle bouncing off the ungloved hand.
The abstract says
We have explored and dispelled ten misconceptions common to the practice of acupuncture, utilizing an evidence-based approach.
Ohhh. Utilizing an evidence-based approach? I get a nearly physical sensation of pleasure at the thought of utilizing an evidence-based approach on acupuncture. I’d describe myself as tingly.
So, let us see what they have to offer, shall we?
Their Myths
Myth 1: Acupuncture only treats pain.
Well, you got me there. Acupuncture can be used to treat every disease, real and imagined (since all diagnoses in traditional Chinese pseudo-medicine (TCPM), based on pulse and tongue examination are imaginary). But efficacy for every disease, including pain, is zero. It is interesting that in their listing of other processes for which acupuncture is allegedly efficacious, anxiety, nausea and vomiting, all have an important subjective component. Otherwise, they mostly mention variations of, well, pain.
They note
Acupuncture also remains underutilized in hospice and palliative settings. A recent survey on the use of complementary and alternative medicine in hospice and palliative care revealed usage of around 86% for massage therapy, but only 32% for acupuncture.
As if it were a bad thing. 32% of those at the end of life spending limited time and money on useless magical thinking is sad. When my time comes, I am relying on a pitcher of boulevardiers. Oh. And no harp. The music thanatologists at my hospital play a harp. Ain’t no harps where I am going. Electric blues guitar for me. Leave any suggestions in the comments, although I’m not dead yet.
Myth 2: Acupuncture is painful
I can’t really comment, as I can find no studies that evaluate the relative pain of an acupuncture needle. Unless dropping a lung, which would hurt, the needles are too thin to cause much pain, not that I have experienced it. Acupuncturists are lucky that there are no meridians to be unblocked in the ever so sensitive eyes, under the nail beds or in the genitalia. Funny how that works.
It is not pain that you are feeling, oh no says Gaslighting R Us:
“Most of the time what might be described as pain is a chi sensation. It can be heavy, throbbing, or jumping, all of which are positive responses.”
And
once a needle reaches its intended depth, you’re likely to feel a mild, dull ache or a slight tingling sensation. This may be a sign that the treatment is working and the acupuncture point is being activated. You may also feel a heavy or electric sensation. Feelings of warmth may arise at the acupuncture points.
That sensation from a splinter? A bee sting? A mosquito? It is only the activation of an acupuncture point. It is good. Embrace it.
Myth 3: Acupuncturists have minimal education or medical knowledge.
They have extensive edumacation in nonsense. Acupuncture is a system based on ideas of health and disease with zero basis in reality. There are no meridians, there is no chi. TCPM isn’t worth a pair of fetid dingo’s kidneys. What use, really, is mastering the fictions that comprise TCPM? None. Me? I have mastered the healing techniques in Lord of the Rings and always had a batch of Athelas in my satchel. So many of the illnesses I see are due to retained metal after stabbing by a Morgul-knife. Frodo was involved in a sort of anti-acupuncture, I suppose.
The same concepts apply to regulation and licensure of acupuncture, it is fiction that is being regulated and licensed.
You might as well consult Dr. Science. He Knows More Than You Do!
Myth 4: Acupuncture only works through a placebo effect
They note:
Acupuncture treatment is an intervention of synthesized experiences, including dialogue of lifestyle recommendations, diagnostic discussion, and the actual placement of acupuncture needles. This often results in a therapeutic relationship. For this reason, many studies find little statistical significance between real acupuncture and sham acupuncture, which could produce a placebo effect.
That kind of defines a placebo effect. All the alleged beneficial effects of acupuncture are placebo, as has been discussed numerous times here at SBM. The dropped lungs? Those are the real deal.
Myth 5: Acupuncture treatment puts me at risk for infection
They note
Upon review of 12 prospective studies surveying more than one million acupuncture treatments, only 204 primary reports of infection were found.
Using “infection due to acupuncture” as search criteria to utilize an evidence-based approach, I found PubMed had 1983 hits and Google scholar had 75,900 hits, a wee bit more than their vaunted 204 infections. Admittedly, not all the hits represented infections as a consequence of acupuncture, but I suspect there may be a bit of selective reporting here. No. That would not happen. Right? If you are utilizing an evidence-based approach you will utilize the evidence, or so I would suppose. Myth 5 appears to be that the authors did a thorough search of the medical literature and, well, utilized the evidence. Unless ‘utilizing an evidence-based approach’ is a synonym for cherry pick? Not in my thesaurus.
Medicine is all about risk vrs benefit. If a procedure has zero benefit, it should have a zero infection rate. So even one infection is one too many.
If you google acupuncture and look at the images: still no gloves in most of the pictures. It is, fortunately, difficult to infect people. I spent a career taking care of injection drug users who have even worse infection control practices than acupuncturists: licking needles, mixing drugs with tap, puddle or toilet water, reusing needles, etc. Infection is still the exception, not the rule, after an injection. Acupuncturists are just lucky it is hard to infect people.
Myth 6: Serious injury can occur with acupuncture treatment
They noted
According to a review of over a million treatments, 54 primary reports of pneumothorax were related to acupuncture resulting in four fatalities (<0.000 4%). This review concluded that acupuncture treatment is a safe procedure when performed by a skilled and trained acupuncturist.
It was the only review of acupuncture-related complications noted. Odd how they focused on pneumothorax.
If you were to, say, utilize an evidence-based approach, you might run across a 2010 review that found
About 90 deaths after acupuncture have been anecdotally documented in the medical literature.
Using “acupuncture complication” to utilize an evidence-based approach, I found 4443 Pubmed hits and 48,000 Google Scholar hits, again with the same caveats as noted for acupuncture and infection. Myth 6 appears to be that the authors utilized an evidence-based approach and reported the findings of a thorough search of the medical literature.
A procedure that does nothing should have no serious complications, much less 90 deaths. The suggestion that the solution is to
make sure that all acupuncturists are well-trained.
is risible. I suspect there is no such thing as a skilled and trained acupuncturist. The best way to avoid complications is to avoid the useless intervention that is acupuncture.
Myth 7: I cannot have acupuncture if I am taking an anticoagulant medication
That does seem to be the case based on the Korean study quoted. A subsequent systematic review I found utilizing an evidence-based approach noted
Bleeding deemed unrelated to acupuncture during anticoagulation, and more likely resulting from inappropriately deep needling damaging tissue
Huh? Isn’t inappropriately deep needling damaging tissue due to acupuncture? I guess by that criterion, dropping a lung isn’t due to acupuncture either, but from inappropriately deep needling. SCAMs can be so Humpty Dumpty. But it reinforces the understanding that acupuncturists really do not know what they are doing with their needles.
Myth 8: Acupuncture is not safe during pregnancy
Probably true, the data, such as it is, suggests
Total AE incidence was 1.9%, and the incidence of AEs evaluated as certainly, probably or possibly causally related to acupuncture was 1.3%.
Again, why have a side effect from a useless procedure? Acupuncturists do fret about allegedly ‘forbidden’ points that can induce abortion, but that is a crock as well.
Myth 9: Acupuncture works after a single treatment
The most important myth, as it affects the income. Like chiropractic, you must keep coming back for more of the $ame.
Acupuncture is known to have a cumulative effect, meaning one treatment builds on the next. Many factors influence the effectiveness of acupuncture, including the timing of treatment and discontinuing treatment earlier than recommended. Many people seek acupuncture treatment after they have exhausted other options, which can reduce the effectiveness of acupuncture treatment and/ or require a longer series of treatment.
Myth 10: I have to choose between acupuncture and my traditional medical treatment, I cannot do both
That is true. I am usually reading both a fiction and non-fiction book at the same time, one audio, one print. Your patient can certainly do reality-based medicine and acupuncture at the same time. But, to quote me, and I am so quotable, if you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.
Most remarkable is the amount of evidence they either did not read or chose to ignore while “utilizing an evidence-based approach.” Insert Princess Bride meme. I am no longer quite so tingly. Sigh.
The authors are from the Mayo Clinic in Rochester, Mn. As an aside, I did my internal medicine residency at Hennepin County Medical Center in Minneapolis. It was not unusual for patients to go to the Mayo for a second opinion (1) and return with no change in the diagnosis or treatment but with a lot of repeated tests and smaller bank accounts. It remains as true today and 40 years ago: “Hold the Mayo.” Except when it is cool.
My Myths
Myth 1 Acupuncture is a monolithic intervention.
There is no such thing as acupuncture as a unified, consistent, intervention. Which is to be expected as acupuncture is divorced from reality. I once counted 32 different styles of acupuncture, each with different points and needlings. I got tired of counting them, there are so many more. There are likely as many styles of acupuncture as there are acupuncturists. It is nonsense to say ‘acupuncture’ does anything given the heterogenous nature of the intervention.
Myth 2 Acupuncture is grounded in anatomy and physiology aka reality
Meridians, chi, tongue and pulse diagnosis, the entire foundation of traditional Chinese pseudo-medicine, is built on smoke and mirrors. Acupuncture is all sound and fury, signifying nothing.
Myth 3. Acupuncture ‘works’
Acupuncture does nothing for any process with an objective endpoint. It is all placebo, all the time. Dr. Novella has characterized acupuncture as theatrical placebo, an excellent description. Like all placebo effects, many feel better for the participation. I think of the placebo effect as primate grooming. Primates that groom and are groomed experience many salubrious effects. The main difference between grooming and alternative medicine such as acupuncture is one removes parasites, the other is a parasite.
Myth 4 Acupuncture is ancient
Go back to the beginning of this blog for multiple articles on the details, where there were many entries debunking the idea that acupuncture is ancient. The title. Yeah. I know.
Really good myths? Listen to Stephen Fry’s Mythos. Those are some myths worthy of your consideration.
(1) I always think of this old chestnut when someone suggests a second opinion:
Doctor: You’re crazy.
Patient: I want a second opinion.
Doctor: You’re ugly as well.