On Acupuncture

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It’s difficult to understand how a supposedly beneficial technique can be both hotly defended as useful by some people, while others spend a great deal of effort trying to dismiss it. Surely, something that has been in widespread use for a century or more should by now have been either confirmed to be effective, or discarded as useless? Considering the enormous cost of medical care today, such a cheap treatment could easily benefit millions, so why don’t we know one way or the other?


Scientific Controversy

One thing to keep in mind when exploring the results of medical trials is that there is likely to be a great deal of money involved, careers at stake and reputations to maintain. This may not be in the purest scientific spirit of impartial inquiry, but it does play a role. It is just one of the possible reasons for scientists disagreeing with each other over the proper interpretation of the same data. 


There is rarely a case of actual corruption involved: researchers, like other professionals, tend to see what they want to see, which is often the same thing the organization paying the bills is most interested in proving. In fairness, competition for academic research positions is extremely fierce, so research funding is very much a career lifeline, whatever its source. For an example of how this can work, the connection between tobacco smoke and lung cancer had been suspected since the 1920’s and proved to a high degree of certainty by 1950, yet a decade later only a third of doctors in the United States considered the case clear-cut. By contrast, a medical researcher who tries to deny this link today will at best face a controversy, and quite possibly be accused of falsifying his evidence. 


A second thing to keep in mind is that medical research actually tends to be extremely rigorous, and just understanding papers published in the field requires a working knowledge of statistics, diagnostic and treatment procedures, microbiology and several other sciences. This is another, more legitimate reason for disagreements in the scientific community: some things are just not known for certain, and certain issues are too complex to allow simple answers. 


When some research study contradicts the results of another, experimental designs can be combed over to find errors, data can be compared to that of prior trials, or new research can be done if someone is sufficiently interested. Through this slightly competitive process of peer review, good science eventually drives out the bad. The problem when it comes to determining the efficacy of acupuncture is that few people are sufficiently interested in funding research on the large scale required. Drug manufacturers are extremely profitable, and they stay that way by funding research on the curative properties of new chemicals, not blue-sky ideas which won’t ever turn a profit.


The Detractors’ View

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It would be a very bad idea to first assert that a new course of medicine is safe and effective, then start selling it to see if the claims are true. For this reason, scientific hypotheses are almost invariably framed in a way that assumes that what most informed people believe in is true, and the heavier burden of proof placed on any new theory. Expressed at its most basic, this proof consists of two numbers: a performance metric such as the average decrease in blood pressure measured during a trial, and the level of significanceor statistical certainty that some aspect of a new theory is true. The latter is why it’s not uncommon for important medical studies to be performed on thousands of subjects over a period of years, leading to their high expense.


If such a performance metric or significance level is too low to support the new theory, technically speaking the old theory is not proved true, but is not rejected at the present time. While this may seem like a backwards way to go about searching for knowledge, numerous very smart people over the years have found this to be the best approach in terms of guarding against both conceptual and experimental errors. Both are unfortunately prevalent in the existing scientific literature on acupuncture, which means that studies can’t be compared one with another, nor are the data they yield necessarily subject to statistical analysis.


So, the most scientific view based on currently available peer reviewed data is that, if acupuncture is indeed effective, its effects are too small to be detected experimentally. Put another way, its curative properties can be compared to giving someone a pill filled with sugar and chalk dust: some patients will indeed get better on their own, but the “treatment” has nothing to do with it.


More research may change this view, but this is unlikely to happen any time soon. Although there are formal courses in acupuncture, it’s much more difficult to assess whether a practitioner is well-qualified in the same way as an M.D. is required to be, which makes research more difficult to carry out. In addition, any such study requires a huge amount of skilled labor, volunteers who have faith in the technique as well as an equal number who don’t, and piles of cash.Based on the existing evidence,this will be better spent elsewhere. 


The Supporters’ View

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Within the scientific community, there are still a large number of doctors and researchers who believe that the evidence for acupuncture being a useful form of treatment is quite strong for particular conditions such as pain management, clinical depression and arthritis. In some cases and countries, it is offered much like nutritional advice: not as a replacement for proven methods of care, but as a supplement to it – this way, if it does not work for a particular patient, there’s no real harm done.


Similarly to those who are skeptical about acupuncture, its supporters also point out that it’s very difficult to do research on. There are several different forms of it, which makes comparing their results statistically very difficult. Also, nobody really knows how it works. In conventional medical studies, some intervening variable linked to disease symptoms can often be measured directly and precisely, for example through chemical blood analysis. Without some insight into acupuncture’s working mechanism, these intervening variables can’t even be identified.


Unlike scientists, who tend to be more guarded in their opinions in the absence of proof, numerous people ascribe their recovery from a huge range of conditions to traditional Chinese medicine, of which acupuncture forms part. This kind of evidence can’t be processed scientifically (for instance, how would a researcher go about finding a proportional number of people who didn’t notice any benefit?), but it’s also difficult to ignore when there’s a huge amount of it.


While the controversy over the effectiveness of acupuncture and other alternative remedies continues, the average man in the street can make little sense of the science regarding such a polarizing issue. For hard facts, the statistics gathered by accepted scientific methods remain the gold standard, but what about the large amount of anecdotal evidence for the effectiveness of acupuncture? Perhaps there is some unknown factor that causes it to be effective for some but not for all. Perhaps this is only an example of the placebo effect. In either case, it’s cheap enough and harmless enough to make it possible for all of us to conduct our own experiments and act accordingly. As far as your own health is concerned, you’re really welcome to do whatever makes you happiest.