Pinning down acupuncture: It's a placebo (by Andy Ho）

The Straits Times
12 Feb 2011
Saturday

By Andy Ho

THE Singapore Medical Association (SMA) desires that doctors here be permitted to refer patients to traditional Chinese medicine (TCM) practitioners.If this suggestion is accepted by the Singapore Medical Council, I believe the practice of evidence-based medicine - and patient interests - will suffer a blow.

Of late, some doctors seem to have embraced even disproven remedies. Take, for instance, a review of acupuncture research that appeared last July in the New England Journal of Medicine. This highly respected journal is one of the most widely read by doctors across specialities.

In Acupuncture For Chronic Low Back Pain, the authors reviewed clinical trials done to assess if acupuncture actually helps in chronic low back pain. The most important meta-analysis available was a 2008 study involving 6,359 patients, which 'showed that real acupuncture treatments were no more effective than sham acupuncture treatments'.

The authors then editorialised: 'There was nevertheless evidence that both real acupuncture and sham acupuncture were more effective than no treatment and that acupuncture can be a useful supplement to other forms of conventional therapy for low back pain.

'First, they admit that pooled clinical trials of the best sort show that real acupuncture does no better than sham acupuncture. This should mean that acupuncture does not work - full stop. But then they say that both sham and real acupuncture work as well as the other and thus is useful.

Translation: Please use acupuncture as a placebo on your patients; just don't let them know it is a placebo.The authors trotted out the same conclusion after they reviewed an important German trial which also showed acupuncture to be merely a placebo.

In any randomised and blinded clinical trial of any mode of treatment for any condition, the finding that the treatment is no better than a placebo always leads to one conclusion only: It is therapeutically useless.

Acupuncture, it would seem, is excepted from this rule.A final study chosen for review was a 'pragmatic' trial that was bereft of any use because, as the authors said, 'neither providers nor patients were blinded to treatment. Therefore, a bias due to unblinding cannot be ruled out'.

In fact, such a 'trial' is inherently biased.Then, as spinmeisters, the authors concluded with a flourish: 'Acupuncture... has not been established to be superior to sham acupuncture...

However, (it) may be more effective than usual care, (so) it is not unreasonable to... incorporate acupuncture into... the management of chronic low back pain.'Balderdash!I should add that I am not criticising TCM per se. Only acupuncture, a facet of TCM, albeit its most dramatic, is being scrutinised here. Chinese herbology must be analysed on its own merits.Interestingly, although acupuncture may be TCM's poster boy today, the Chinese physician in days of yore would have looked askance at it.

Instead, his practice and prestige were based upon his grasp of the Chinese pharmacopoeia.Acupuncture was left to the shamans and blood letters. After all, it was grounded, not in the knowledge of which herbs were best for what conditions, but astrology.In Giovanni Maciocia's 2005 book, The Foundations Of Chinese Medicine: A Comprehensive Text

For Acupuncturists And Herbalists, there is a chart showing the astrological provenance of acupuncture. The chart shows how the 12 main acupuncture meridians and the 12 main body segments correspond to the 12 Houses of the Chinese zodiac.

In Chinese cosmology, all life is animated by a numinous force called qi, the flow of which mirrors the sun's apparent 'movement' during the year through the ecliptic. (The ecliptic is the imaginary plane of the earth's orbit around the sun).Moreover, everything in the Chinese zodiac is mirrored on Earth and in Man.

This was taught even in the earliest systematised TCM text, the Yellow Emperor's Canon Of Medicine, thus: 'Heaven is covered with constellations, Earth with waterways, and man with channels.'This 'as above, so below' doctrine means that if there is qi flowing around in the imaginary closed loop of the zodiac, there is qi flowing correspondingly in the body's closed loop of imaginary meridians as well.

These meridians run from head to toe to form a network interlinking 361 points on the skin. But why are there 361 points? Since the earth takes three minutes under 24 hours to rotate 360 degrees on its axis, the sun appears to revolve through 361 degrees on the ecliptic every 24 hours. Hence 361 points.

This factoid alone is sufficient to nail down the acupuncture-astrology linkage.Since qi flows around in a closed loop, needles can be inserted at one of these points far removed from your site of pain to rechannel qi.

If done well, this supposedly can cure your spot of trouble.Note that not only is acupuncture astrological in origin but also the astrology is based on a model of the universe which has the earth at its centre.
This geocentric model was an erroneous idea widely accepted before the Copernican revolution.

Today, no one believes the earth is at the centre of the universe. [Not true! ST Feb 10, 2011: Third of Russians think sun revolves around earth: Poll*] But the ancient Chinese saw this geocentric principle organising all of nature as well. From its accompanying astrological system, acupuncture was birthed.

So should doctors check the daily horoscopes of their patients?

andyho@sph.com.sg