Posts Tagged ‘acupuncture’
it’s all about evidence, part 2: acupuncture and cupping
a picture of health
Okay, having been sick myself with my usual bronchial issues, I haven’t made much progress on researching the ‘alternative’ treatments offered by Wesley Smith and his colleagues at the Wellness Centre. I must admit, too, that I’ve found it a bit depressing focusing on these negatives, so I’ve been working a bit on my Solutions OK blog (a few posts still in preparation) which focuses on being positive about global issues.
So before briefly dealing with acupuncture, I’ve discovered accidentally through looking up Mr Smith that ‘wellness centres’ or ‘total wellness centres’ are everywhere around the western world, including at least one more in Canberra itself. It seems that this is a moniker agreed on by practitioners of holistic medical pseudoscience world-wide, to create a sense of medical practice while avoiding the thorny issue of medicine and what it actually means. But maybe it does partially mean treating people kindly? I’m all for that. Laughter is often quite good medicine, especially for chronic rather than acute ailments.
It’s an interesting point – ‘alternative’ medicine is on the rise in the west, and the WHO informs us that by 2020, due to its own great work and that of other science-based medical institutions, the proportion of chronic ailments to acute ones will have risen to over 3 to 1. It’s in the area of chronic conditions that naturopathy comes into its own, because psychology plays a much greater part, and vague ‘toxins’ and dubious ‘balance’ assume greater significance. That’s why education and evidence is so important. There are a lot of people out there wanting to smile and seduce you out of your money.
Acupuncture
There’s no reason to suppose acupuncture is anything other than pure placebo. It’s similar to homeopathy in that it proposes a treatment involving physical forces that, when tapped, can produce miraculous cures, and it’s also similar in that these forces have never been isolated or measured or even much researched. In the case of homeopathy, Samuel Hahnemann, its inventor, conducted ‘research’, but with no apparent rigour. See this excellent examination of his approach.
Acupuncture posits Qi (pronounced ‘chee’) as an energy force – apparently invisible and undetectable by mere science – which operates under the skin and is ‘strongest’ at certain nodes where experts insert needles to stimulate it. There’s not much agreement as to where exactly these nodes are, how many there are, or how deep under the skin they’re to be found. Is everybody’s Qi the same? Is the Qi of other mammals identical? If you haven’t enough Qi, can you have a Qi transfusion, or will you be contaminated by the wrong Qi and suffer a horrible death? Amazingly, acupuncture practitioners have no interest whatever in these life and death questions. Why has nobody thought to operate on a patient and withdraw a sample of her Qi, considering that the stuff has been known about since ancient times? It’s a puzzlement. And with that I’ll say no more about acupuncture.
Cupping
Cupping, or cupping therapy, is fairly new to me – I mean I’ve heard about it over the years but I’ve never bothered to research it. It was apparently used in Egypt 3,000 years ago, and it’s considered a part of TCM (traditional Chinese medicine). How it got from Egypt to China is anyone’s guess, but when used there, it’s associated with our old friend, the non-existent Qi. Yes, according to TCM, much disease is due to blocked Qi, and cupping is one way to fix it.
Briefly, there are two kinds of cupping, wet and dry, with wet cupping being the more ‘invasive’ and used for more acute treatments. The idea is to create a vacuum which draws the skin up in the cup and increases the blood flow. The cup, or the air inside it, is heated, and when the cup is applied to the skin and allowed to cool, the air contracts, ‘sucking up’ the skin. With wet cupping the skin is actually punctured, so that those nasty but never-quite-indentifial ‘toxins’ can ooze out. By the way, next time you go to your naturopath to get your toxins removed, ask them for a sample, and don’t forget to ask them to name those toxins. Perhaps you could look at them under a microscope together.
There’s very little in the way in the way of evidence to support the effectiveness of cupping, and as you might expect, the best ‘evidence’ comes from the most poorly controlled trials. Serious and obviously dangerous claims have been made that cupping can cure cancer. Here’s the American Cancer Society’s response:
“There is no scientific evidence that cupping leads to any health benefits….No research or clinical studies have been done on cupping. Any reports of successful treatment with cupping are anecdotal. There is no scientific evidence that cupping can cure cancer or any other disease.”
If cupping was effective, this would be easily provable. No proof has been offered in thousands of years, and there’s no credible scientific mechanism associated with the treatment. You’ve been warned. It’s your money. Why hand it over to these parasites?
the myth of holistic medicine
It does get my goat rather that so-called naturopaths, in spite of having varied and often contradictory therapies, love to call themselves practitioners of holistic medicine. It’s a feel-good term that, like spirituality, seems to make a virtue of its own vagueness. Of course, holistic medicine can be defined in a superficial sense – it’s treating the whole person, right? But how does that work in reality, and how do naturopaths manage it?
Well, the obvious answer is, they don’t. It’s nothing more than a propaganda term.
Clearly, holistic, whole-person treatment would be fabulous if it could be achieved, but it would entail not only knowing the whole anatomy and physiology of the client, but her psychology and her entire medical history from birth, and even before. Would there be any other way of treating ‘the whole person’?
Personalised medicine may in fact become the way of the future – I’ve heard as much – but that has nothing to do with naturopathy. That has to do with science – your personal microbiome, your heart rhythms, your cholesterol, your triglycerides, your lung function, your bowel movements, your bone density (not to mention your sequenced genome), taking more responsibility for those things as far as is possible and in co-operation with healthcare providers. Naturopathy is something else altogether – it’s about herbs instead of pills (unless they’re homeopathic), ‘age-old’ treatments such as reflexology and TCM rather than invasive tests and vaccinations, getting in tune with or detoxifying your body rather than taking impersonal prescriptions to your local impersonal pharmacist.
So the question is – how did taking an entirely chemical herbal treatment from a naturopath come to seem more holistic than taking a chemical such as theophylline prescribed by your specialist?
I don’t see how a naturopath would or could treat a client as a ‘whole person’ any more than a conventional GP could. Limited info, limited time, it’s the same whether your treatments are science-based or traditional. But I do know at least one happy client who swears by her naturopath, who really does treat the whole person, unlike the medical establishment, according to her. I haven’t pressed her to explain this, but I have my own nasty theory. The woman is clearly obese, and wouldn’t take kindly to being told so, and she’s found a practitioner whose greatest skill is to tell her everything but what she most needs to hear. At last, someone who really understands her, who really listens and accepts her own expertise about her own body. And it must be said that many doctors, full to the brim of years and years of training and practice, do sometimes treat their clients in an offhand or specimen-like way. The psychological effects of healthcare practice are surely underestimated. So many people, but especially the unhealthy, want to be seen as, or made, whole. ‘Holistic medicine’ therefore, makes for a very effective propaganda label.
Yet many treatments that eagerly make use of the holistic banner are about as far from being individualised as can be imagined.
Acupuncture supposedly manipulates your ‘chi’ or ‘qi’, a system of energy flow that, if it existed, could be individualised to the client. Some clients might have a different chi from others, just as we have different blood types, different hormonal levels, different cholesterol levels, different insulin levels, etc, all of which can be measured. But acupuncturists don’t measure our chi levels and give us a read-out. Why ever not? Surely that would be the holistic, personalised thing to do. The fact is, nobody, in the supposedly thousands of years of acupunctural history, has ever thought to isolate this energy force and describe its wave function or the molecules or particles associated with its action. Nobody has even shown the slightest curiosity about the physical properties of what is advertised as a fundamental energy source in humans and perhaps all other living things. That’s fucking amazing – the only amazing thing I can say about acupuncture. Yet, apparently, there are particular points in the body where chi is more abundant, and that’s where you should stick your needles, and at a certain depth, otherwise you won’t be in touch with the chi. So acupuncture depends entirely upon chi being a physical, measurable entity…
Say no more. Your chi can’t be personalised and made a part of your whole-person profile because it doesn’t exist.
Homeopathy also likes to travel under the holistic banner, and you’ll find it advertised in all those brochures featuring glowingly healthy individuals, often dressed in white, meditating or staring lovingly at the sky-spirits. The trouble is, homeopathic treatments are designed to treat the illness, not the individual. The bogus ‘law of similars’ involves swallowing pills which are supposed to contain material ‘like’ whatever it was that made you sick. If that doesn’t sound very scientific, don’t blame me. It’s obviously a problem if you don’t know what made you sick, but the solution is simple. Just pay attention to your symptoms – say itchy skin or funny-coloured urine – and take pills containing a substance that produces similar symptoms. But hang on, won’t that just make you more sick? No, not at all, because the offending substance will be diluted to infinitesimal proportions. Okay, but won’t that render it useless? Ah but you’re clearly unaware of the ‘law of infinitesimals’ which defines a substance as increasing in potency the more it’s diluted. Welcome to the world of homeopathy, where the more truth is watered down, the more obviously true it becomes.
But the point I wanted to make here, before becoming entranced by the homeopathic mindset, was a simple one. Far from treating clients as ‘whole people’, it is solely concerned with physical symptoms. A homeopathic treatment would work just as well on a horse or a hedgehog as on a human. The client’s humanity, let alone her particular history or psychological make-up, isn’t a factor. It’s as far removed from holistic medicine as you can get.
I could go on – reflexology, iridology, reiki, chiropractic – these are all bogus, and the fact that they all jump eagerly onto the holistic bandwagon is further evidence of their crappiness. Holistic medicine is an impossible ideal, though personalised medicine, where you take personal responsibility to educate yourself about and keep records of your own health and physical maintenance, in collaboration with health specialists, is a great way to go. And that involves a lot more than just holding hands in a smiley circle.
acupuncture promotion in australia
I tried to find a picture of the chi energy system online, but guess what, nothing to be found. Here’s a chi-reflexology map instead – from the Australian College of Chi-Reflexology, no less!
On the ever-reliable US-based NeuroLogica blog, Steven Novella reports on an interesting case of acupuncture promotion here in Oz, via Rachel Dunlop. As Novella reports, acupuncture has been studied many times before, and Cosmos, our premier science mag, did a story on the procedure a while back, reporting no evidence of any benefits except in the notoriously vague areas of back pain and headaches.
Not surprisingly, lower back pain was one of the conditions that supposedly benefited from acupuncture, according to media hype about the latest study. The trouble is, this study was being reported on before being published and peer reviewed, which, to put it mildly, is highly irregular and raises obvious questions. The Sydney Morning Herald is the offending news outlet, and Dr Michael Ben-Meir the over-enthusiastic researcher. As the article points out, Ben-Meir is already a ‘convert’ to acupuncture, having used it for some time in acute cases at two Melbourne hospitals. That’s fine, if a bit unorthodox, but it doesn’t accord with other findings, and there are therefore bound to be questions about methodology.
One of the obvious difficulties is that acupuncture can hardly be applied to patients without them knowing it. It’s a much more hands-on and ‘invasive’ experience than swallowing a tablet, and this will undoubtedly have a psychological effect. It seems to me, just off the top of my head, that acupuncture, with its associated rituals, its aura of antiquity and its oriental cultural cachet, would carry greater weight as a placebo than, say, a homeopathic pill. But in fact I don’t have to speculate here, as there is much clinical evidence that injections have a greater placebo effect than pills, and big pills have a greater placebo effect than small ones. So it doesn’t greatly surprise me that people will report a lessening, and even a dramatic lessening, of acute pain, after an acupuncture treatment, however illegitimate. I presume there are illegitimate treatments, because the ‘key meridional points’ where the needles are applied are precisely know by legitimate acupuncturists, and they apply their treatments with rigorous accuracy.
Well, actually there’s a big question as to whether or not there are any legitimate acupuncturists, because acupuncture is based on an energy system known as ‘chi’, which supposedly has meridional points at which needles can be inserted quite deeply into the skin, but there’s no evidence whatever that such an energy system exists, let alone about how such a system might function – for example, its mode of energy transmission (whatever ‘energy’ might mean in this case). Considering that we know a great deal about the autoimmune system and the central and peripheral nervous systems, it seems astonishing that this other bodily system has gone undetected by scientists for so long, and especially in recent times, with our ultra-sophisticated monitoring devices. When you look up ‘chi, sometimes spelt ‘qi’ or with other variants, you’ll find nothing more specific than ‘energy’, ‘life force’ or something similar – nothing corpuscular or in any sense measurable by modern medicine. Even so, researchers into acupuncture have come up with an attempt to measure its efficacy by comparing it to ‘sham acupuncture’ in clinical trials. Sham acupuncture uses the ‘wrong’ meridians and the ‘wrong’ depths to which the needle goes.
But herein lies an obvious problem. Sham acupuncturists insert needles only millimetres deep, while real acupuncturists put their needles between one and three or four centimetres deep: ‘Depth of insertion will depend on nature of the condition being treated, the patients’ size, age, and constitution, and upon the acupuncturists’ style or school’, according to an acupuncture site I visited at random. These are rather wide parameters, but the point that interests me is this. If you don’t put your needle in deep enough, you won’t make contact with the chi that needs to be stimulated or other wise modified to heal the patient. So goes the rationale, surely. It’s like, if you don’t put the needle for a standard vaccination in the right place, you’ll miss the vein. But veins are clearly real. If you go dissecting, you’ll find veins and arteries and nerves and muscle and fat and so on. But you won’t find chi. Yet, apparently it does have real existence. It’s between one and four centimetres down, according to real acupuncturists, depending on the above-mentioned variables (and no doubt many others).
So we can’t actually see it, or find it on dissection, but it’s locatable in space, vaguely. Or is it that chi is everywhere in the body but the right kind of chi, the bit that’s causing the pain and needs to be treated with needles at certain precise meridional points, is at a certain distance from the surface of the skin?
It all begins to sound a bit like theology, doesn’t it?
Here’s the ‘take-home’ for me. If you read about treatments that ‘work’ but you get virtually nothing about the mechanism of action, as is the case, for example, with homeopathy and acupuncture, be very skeptical. In the end I’m not impressed with clinical trials that show a ‘real effect’, even a startling one, because I know about regression to the mean, and I particularly know about the placebo effect. I want ‘proof of concept’. In this case proof of the concept of chi and of meridians. I’ve heard homeopaths defend their pills on TV recently by claiming that, ‘whatever the mechanism, clinical trials consistently prove that this treatment works’, and I can’t be bothered chasing up those clinical trials and testing their legitimacy, I go straight to the concepts and processes behind the treatment – the law of similars, the law of infinitesimals, and don’t forget succussion. These concepts are so intrinsically absurd that we needn’t bother looking at the clinical data. If there are positive results, they haven’t been produced by homeopathy. The fact that homeopaths themselves are largely uninterested in the mechanisms is a dead giveaway. You’d think that the law of infinitesimals and the law of similars would surely have myriad applications far beyond their current ones. They would revolutionise science and technology, if only they were real (and they’d also render obsolete much that we currently know).
The same goes for acupuncture, and chi. If this bodily system were real, and chi could be captured in a test tube, and its constituents examined and isolated under a microscope, how revolutionary that would be. How transformative. Chi pills, chi soap, chi breakfast cereal…
Ah but I’m thinking like one of those limited westerners, so modern, so smug, so lacking in the insight of the ancients…