And you may find yourself living in a shotgun shack
And you may find yourself in another part of the world
And you may find yourself behind the wheel of a large automobile
And you may find yourself in a beautiful hospital, getting beautiful acupuncture
And you may ask yourself, “Well, how did I get here?”
– Talking Heads. Sort of.

I had a lot of indecision trying to come up with a title for this entry. I considered Frozen Blather, MAGA: Making Acupuncture Great. Again. and Plus c’est la même chose, plus c’est la même chose (the more things stay the same the more things stay the same). Perhaps a Waiting for Godot reference? But I decided on Zeno’s paradox. Zeno was a warrior princess who, for revenge, published her spine-injured doctor’s address on the internet. Something like that.

The headline, over at Time.com reads “Why Acupuncture Is Going Mainstream in Medicine“.

It is? Again? Still? Acupuncture, and all the other SCAMs, have been going mainstream since long before I developed an interest in the topic, circa 2006. There are 16,900,000 hits using ‘alternative medicine goes mainstream’ as a search term. 1,590,000 for ‘acupuncture goes mainstream’. As best I can determine, alternative medicine has been going mainstream on the net since 1998 and acupuncture since 2002. The earliest Pubmed article goes back to 1993.

That mainstream must be choked with a log jam of SCAM pollution by this point. But SCAMs, and acupuncture, never really reached the mainstream. I am not convinced that acupuncture has moved an inch in that direction. Maybe I should have called the entry Red Queen Acupuncture.

Decisions, decisions.

In my first round at SBM I always enjoyed deconstructing acupuncture articles, and it is quite striking to see that in the five years I have been away, nothing has changed. Not that I expected it to. Nothing ever changes in the world of SCAM. I was told that half of everything I learned in medical school would be found to be incorrect, which is part of why there is ongoing medical information. When, as in the case of most SCAMs, 99% of what you learn in school is BS, you just stick with the BS and rarely if ever learn anything new. So much easier.

So let’s take a trip down memory lane courtesy of Time magazine, or Time digital magazine. As we will see, with the usual SCAM tempest in a teapot, what’s past is prologue.

First, the accompanying photo. Acupuncture sans gloves. As always. As an infectious disease doctor, gloveless needling gives me the willies. Looking at Google images for acupuncture, no one wears gloves. MRSA, here we come. I did search for acupuncture gloves and, unlike the last time I used those search criteria, there are actually a few photos of acupuncture (not dry needling, although the same thing) using gloves. Not as many as acupuncture gloves, a form of hand covering to stimulate acupressure points on the hand. There were even practitioner’s using masks, although I was not certain if it was due to COVID or for infection control purposes. Or to hide their identity while performing an unnatural act.

So let’s wander through the content.

It starts with a pain specialist (relieving not inflicting) who “wanted to recommend a remedy that was safer and still effective [than opiates] That turned out to be acupuncture”.
Wrong.

I feel sorry for those with chronic pain. Opiates are without a doubt a bad therapeutic option. But with a shortage of interventions, some medical practitioners encouraged to turn to the magic of acupuncture. And magic doesn’t work. But I will grant magic is safer than opiates. Sometimes.

When I started looking into studies, I discovered how much evidence there was behind this treatment.

Bad evidence from poorly done studies, yes. But not quality evidence you would want to apply to patients. Quantity can be impressive. I would be impressed by a Mt Hood-sized pile of cow dung but I would not want it for dessert.

That blend of anecdotal success, research-backed results, and growing level of openness from the medical community are all driving the popularity of acupuncture as a therapy.

Always remember, the plural of anecdote is anecdotes, not data, although the pleural of infection is empyema. The research, as noted above and at length on this blog, is lousy.

The openness of the medical field? Probably stems from the need, when presented with humans suffering, to do something, anything, to help the patient. At least sending the patient to the acupuncturist is doing something. Well, not really.

Although scientists don’t yet understand all the nuances of how it works,

Yes, they do: acupuncture is a Theatrical Placebo.

Time then pulls a Louie and reproduces the usual acupuncture myths and factoids.

The first is that acupuncture is a unique thing, a monolithic approach to disease. Acupuncture should be a plural word there are so many variations of the intervention. Or maybe, like dirt, acupuncture is both the singular and plural of the word. And there is Control Dirt – Master’s Tung’s Acupuncture Point, which is useful of Smeagols ‘herpeses’. I need to apply Master Tung’s approach to our English Bulldog.

But I digress. Which is what I want on my tombstone.

There are innumerable acupuncture styles, likely as many as there are practitioners. Since acupuncture is divorced from reality, each practitioner can, and does, use a unique style of acupuncture. Whose style reigns supreme? They all do.

Acupuncture is thousands of years old. Nope, acupuncture as we know it is a recent invention. Until recently acupuncture was quite barbaric, using tools and techniques more appropriate for Marathon Man than a medical office. Animal bones and stones gave way to devices no one would want stuck in them long before thin steel needles and sterile techniques were understood.

The practice is based on how energy, or qi, flows through the body along a series of channels called meridians—similar to the way nerves and vessels carry messages and blood throughout every system.

It cannot be similar to nerves and vessels because meridians and qi do not exist.

It is lunacy to try and treat disease effectively when your key concepts are completely unhinged from reality. You might as well credit the ancient concepts of humors as the basis of your medical interventions.

But Time states this stop-the-steal-level fantasy as fact. Or perhaps they are only certain “…each meridian is related to a specific organ, and placing thin needles at certain points along these meridians can effect certain changes in the body to restore homeostasis”.

When I write I try to get rid of any ‘it’ as it is often not clear what it is referring to. Like ‘is’. And like ‘certain’ in the above paragraph. Clear as mud.

Ever wonder how these superficial meridians connect to deep organs? And how altering something on the skin can cause effects on the heart or liver? Never really explained is how these superficial interactions cause changes deep within organs. Wait. I bet it is quantum. You know, that spooky action at a distance of quantum entanglement. This is the truth. I wrote that penultimate sentence and then did a search, thinking, no way. Way. I found “Discussion on quantum entanglement theory and acupuncture“:

…the quantum entanglement phenomenon is mutually verified with the holism, yinyang doctrine, the theory of primary, secondary, root and knot in TCM, etc. It can be applied to interpret the clinical situations which is difficult to be explained in clinical practice, such as the instant effect of acupuncture, multi-point stimulation in one disorder and the points with specific effects. On the basis of the discovery above, the quantum entanglement theory achieved the mutual treatment among the relatives in acupuncture clinical practice and the therapeutic effects were significant. The results suggest that the coupling relationship in quantum entanglement presents between the diseases and the acupoints in the direct relative.

Good gods. Although the article was retracted because it “has some defects”. You think?

And my usual question: why are there no acupuncture points/meridians in the eyes, nail beds, or the genitals? One would think that the something as vital to life as qi would be in the life-producing organs. The answer is obvious to all but the most committed masochist. But good news for erectile dysfunction patients, the problem lies distant.

TCM believes that the etiology and pathogenesis of ED is related to spleen and kidney deficiency and qi and blood block.

A particular relief if fire acupuncture or the plum needle is to be used for ED. I really do not want to know.

Time continues:

Placement along the meridians is believed to cause reactions like sending more blood or lymphatic fluid to specific organs or allowing muscles to release in a way that reduces tension on joints and bones.

I have read that over and over and I do not really understand it.

Belief is what you have when there are no facts to support your contention. Also, I thought the effect of acupuncture was restoring proper qi flow. Now, it is altering blood and lymph flow to organs. And, by the way, I was under the impression that lymph flowed away from organs, a way of returning fluid to the circulation. And “allowing muscles to release in a way that reduces tension on joints and bones”. Huh? Muscles have more than one way to relax?

And once the needles are removed from these points, what keeps the qi from returning to its prior abnormal flow state? And if the qi is flowing like blood through meridians, why and how do the needles cause the flow of qi to normalize? If I were to stick a needle in your radial artery for 20 minutes, I doubt it would improve the blood flow. And how does one know the qi is normalized? You don’t.

The needles may also stimulate nerves and tweak nervous system regulation to result in a relaxation response, which relieves pain.

May stimulate? Or may not. Now is not the qi flow, or blood, or lymph, but a tweaked nerve? But consistency, internal or otherwise, is not a strong point for any SCAM.

Research on acupuncture has been extensive, and so far, robust evidence supports its effectiveness for some, but not all, conditions.

As this blog consistently points out when evaluating SCAM studies, while there is extensive research, none are robust and the better the study, the poorer the acupuncture effect.

According to one analysis published in February 2022 in the BMJ that analyzed more than 2,000 scientific reviews of acupuncture therapies, the science is strongest behind acupuncture’s efficacy for post-stroke aphasia; neck, shoulder, and muscle pain; fibromyalgia pain; lactation issues after delivery; lower back pain; vascular dementia symptoms; and allergy symptoms.

Science? You keep using that word, I do not think it means what you think it means. One can only apply science to reality, not fiction. What do any of these diseases have in common pathophysiologically? What does post-stroke aphasia have in common with lactation issues?

I need to come up with a pill that people can take that has the same widespread effects as acupuncture. I would make a fortune.

Remember, originally in Traditional Chinese Pseudo-Medicine (TCPM), diagnosis of ‘disease’ is accomplished by examining the tongue and pulse. Acupuncture has nothing to do with reality-based anatomy, physiology, chemistry, etc. that is the foundation of medicine. How the fiction of TCPM gets mapped onto real disease is never explained.

What all these processes have in common is a large subjective/psychological component. Acupuncture, like all SCAMs, have nothing to offer for diseases like endocarditis, hypothyroidism, pancreatitis, or the myriad of diseases I see or treat every day.

Northwestern Health Sciences University in Minnesota, which focuses on integrative health professions, such as acupuncture, chiropractic, and Traditional Chinese Medicine. For cancer patients, sessions there can focus on reducing nausea, numbness, and tingling (called neuropathy), brain fog, low appetite, acute and chronic pain, and mood challenges that come with cancer care.

I think it is a shame that patients are charged for SCAMs that offer nothing but placebo, the lack of effect being obliquely referred to:

Often, people with cancer want to add complementary treatment that doesn’t affect their chemotherapy or radiation, and that’s where an option like acupuncture can be helpful

It doesn’t affect their chemotherapy or radiation because it does nothing. Placebo for symptoms from reality based therapies?

Medical debt in the US is tremendous and the number one cause of bankruptcy. When I order tests for patients, I remember I am spending their money and they will often end up with a copay. I was in the hospital for less than 24 hours a couple of years ago for small bowel obstruction and this year in the ER for 12 hours with a nasty case of Campylobacter. The former cost $10,000, the latter $8,000. My copay was 10%, not an issue for a physician at my income level. But half of Americans can’t come up with 500 bucks in an emergency.

Here is an unfortunately typical example.

Multiple surgeries, radiation, and chemotherapy controlled the cancer. But, despite having insurance, Peters was left with more than $30,000 of debt, threats from bill collectors, and more anxious nights thinking of her kids.

Should patients acquire debt for this nonsense? I would be one angry dude if I was in horrible debt due, in part, to paying for worthless therapies based on fantasy.

Then Time briefly gets real. After asserting that the basis of acupuncture has validity and that there is robust evidence, they then say

Acupuncture is far from a proven and accepted therapy for most conditions— even for the ones that show promise. That’s in part because the studies that support it are sometimes not high quality, and the field lacks standardized protocols that would better allow it to be scientifically evaluated…the researchers found substantial variations in study quality, acupuncture frequency, how long needles were left in the body during treatment, which points along the meridians were used, and other potentially important factors. That made it difficult to evaluate how effective the acupuncture really was. The field also lacks clear terminology and universally accepted agreement about the location of acupuncture points, researchers argue.

Which is it? ‘Show promise’ or ‘the science is strongest behind acupuncture’s efficacy’? Or ‘studies that support it are sometimes not high quality’?

Time tries to have it both ways, and as is usual, the critical part falls at the end of the article, after the favorable puff piece at the beginning.

The real reason acupuncture is far from proven or accepted, as I mentioned at the beginning, is that acupuncture is totally unhinged from reality.

International experts in the field are pushing to make clinical trials more rigorous in order to prove acupuncture’s utility for patient care and to help providers adopt the best practices as more benefits become clear.

Interesting phrasing. But it is what acupuncture research tries to do: “prove acupuncture’s utility.” When rigor is applied to fantasy, the fantasy fails. Which is why despite decades of research, rigor and SCAM do not mix.

The article mentions future areas for defrauding patients, er I mean, acupuncture application: fertility, depression, and menopause.

As the evidence base expands, acupuncture will likely continue to grow in popularity.

More bad studies in the expanding evidence base? Or the rigorous studies that, like Zeno’s finish line, will never be reached?

Although acupuncture has been used for centuries, only in the past decade has there been a seismic shift in acceptance by both Western medical doctors and patients,

As Talking Heads noted,

Same as it ever was, same as it ever was
Same as it ever was, same as it ever was
Same as it ever was, same as it ever was
Same as it ever was, same as it ever was

Ongoing research efforts and increased interest from health systems means that the treatment may be part of more conversations like Mikhael had with his patients.

I sure hope not, but really, is there any aspect of the current human condition that offers even a glimmer for optimism? There are no more Choco Taco’s for God’s sake. And just as the world is heating up. Oh, the humanity.

“At the end of the day, doctors want their patients to feel better, and many people are looking for non-pharmaceutical paths for wellness,” Menard says. “Depending on the condition, those little needles can make a huge impact.”

Huge impact? Perhaps. But not in the manner acupuncturists think.

Ours is a healthcare ‘system’ that is remarkable for its dysfunction. We have some of the most incredible treatments and diagnostics wrapped in a thick layer of bureaucracy and BS.

The solution? Got me. But it is not in offering the nonsense of acupuncture and other SCAMs.

And Time? Recently they rated Portland as one of the world’s greatest places. Having been a lifelong resident, I can say no. Portland has become, to quote the former guy, a shithole. Maybe Time based their recommendation after binge-watching Portlandia.

Pericles said, “Time is the wisest counselor of all.”

Nope.

When it comes to SCAM, I prefer Dion Boucicault: “Men talk of killing time, while time quietly kills them”.

Author

  • Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.

Posted by Mark Crislip

Mark Crislip, MD has been a practicing Infectious Disease specialist in Portland, Oregon, since 1990. He is a founder and  the President of the Society for Science-Based Medicine where he blogs under the name sbmsdictator. He has been voted a US News and World Report best US doctor, best ID doctor in Portland Magazine multiple times, has multiple teaching awards and, most importantly,  the ‘Attending Most Likely To Tell It Like It Is’ by the medical residents at his hospital. His growing multi-media empire can be found at edgydoc.com.