From depression to myopia to pain relief, acupuncture is said to treat an impressively wide variety of symptoms. Chances are you know someone who’s tried it, or perhaps you’ve even tried it for yourself. You may even have read about it on our blog. In the spirit of promoting education and giving women all the information they deserve to make good decisions about their health, we’ve decided to provide some historical and empirical background on the uses and limitations of acupuncture as a health treatment.
Acupuncture’s origins in the United States may be traced back to 1972, the year of President Nixon’s historic visit to the China, which marked the start of the dissolution of over two decades of hostility and separation between the two nations. During Nixon’s visit, the president observed patients undergoing major surgery. The patients were ostensibly receiving only acupuncture as anesthetic (it was later revealed that these patients were receiving doses of morphine through an intravenous drip under the guise of nutritious and hydrating fluids). Amazed and captivated, reporters accompanying Nixon to China returned to the west with spectacular tales of ancient medicines and miraculous healing.
Long isolated from the east by political conflict, Americans perceived China as exotic and mysterious. As relations between the two countries warmed, the American public was intrigued by rumors of these new eastern riches. Practitioners began to appear all across the US, and in 1973 acupuncture was officially allowed as a deductible medical expense by the IRS. Over the next several decades, acupuncture grew to be a multi-billion dollar industry in the US, and currently more than 10 million acupuncture treatments are administered in the US each year.
Acupuncture is a practice based on an ancient theory of medicine which presumes that bodily functions are regulated by a flow of energy called qi, which moves through invisible channels in the body known as meridians. The practice involves penetrating the skin at certain points, known as acupuncture points or acupoints, with thin metal needles. This practice is thought to balance the person’s qi and treat a wide variety of ailments, including pain, headaches, migraines, depression, infertility, and many more. Acupuncture even outperforms certain traditional and much more expensive treatments that have all sorts of unpleasant side effects.
Despite its cost-savings, effectiveness, and lack of side effects, almost no western medicine practitioners will endorse acupuncture, and it has become a subject of intense debate and study over the past several decades. Proponents of acupuncture wonder why western medicine refuses to acknowledge an inexpensive tool that has helped millions of people manage their health - perhaps acupuncture is a threat to their lucrative market? Such a miraculous cure-all might undermine sales of the expensive chemical medicines that western doctors are quick to push on their patients.
To understand the source of this controversy, we must consider how the philosophies of western medicine and ancient medicines such as Chinese medicine differ. The fundamental concept of western medicine is the scientific method - a series of steps and techniques designed to empirically investigate phenomena in a standardized, replicable way. The scientific method is used to determine a medicine’s clinical effectiveness. A drug is said to be clinically effective when a group of research participants who receive the drug display consistently better health outcomes than two comparable groups. One comparison group receives nothing at all, and the other group receives a placebo, an inert version of the drug which contains no active ingredients (such as sugar pills, for example).
Why does the scientific method require the drug to be compared against a placebo? As it turns out, the simple act of taking a pill with the promise that it will make you feel better can actually make you feel better, even if that pill is nothing but a sugar pill. Even the size, color, price, and name of placebo pills has a massive impact on the degree to which the patient improves. Placebos have demonstrated efficacy rivaling or even outperforming traditional medicine. This is especially true when the ailment in question is subjective, such as pain, anxiety, and depression. Depending on how they are prescribed, placebos can even cause measurable physiological effects, such as changes in heart rate, blood pressure, muscle relaxation, physical and academic performance, and can even help smokers quit. The placebo effect is not just “all in your head!”
As you might imagine, the placebo effect makes it a little harder for researchers to determine exactly how effective new drugs are. After all, if patients improve just from taking pills alone, how can we tell how much improvement was due to the active chemicals in the drug, and how much was due to placebo? Is the active drug actually doing anything - is it a clinically effective drug? This is where the two comparison groups - the group that received nothing and the group that received a placebo - come in to play.
Researchers compare the improvements between the three groups. In a well-designed experiment for a clinically effective drug, researchers would expect to observe three things:
First, the group that received nothing will generally show the least improvement of the three groups. Many illnesses naturally get better or worse over time without treatment. This group’s role in the experiment is to provide a baseline of the natural progression of the illness for comparison.
Second, the group that received the placebo will generally show greater improvement than the group that received nothing, even though the group only took sugar pills. This improvement is evidence of the placebo effect in action.
Finally, the group that received the active drug will show the greatest improvement of all three groups. After all, this group received the combined benefit of the active drug and the placebo effect. By comparing the experimental group’s performance to the placebo group’s performance, researchers can determine approximately how much improvement was due to the drug and how much was due to placebo.
Drugs are only considered clinically effective when the experimental group improves more than the placebo group. If researchers never used placebo groups, we would have no way to know whether new drugs actually do anything - or if we’d do just as well taking a sugar pill.
The spirit of western medicine is the constant empirical testing of knowledge: comparing new treatments to old ones, discarding outdated knowledge, and replacing old treatments with something proven to be better. For example, penicillin, one of the first antibiotics developed to treat previously serious diseases, is hardly used at all anymore - it was replaced when newer, more effective antibiotics were discovered. No doubt many of our popular medications today will be replaced as the field makes new discoveries.
Over the course of its more than 2000 year history, acupuncture has gone through many evolutions of its own. In antiquity, acupuncturists would pierce different places on the body and use different positions than we use now, and they used needles made of stone or bone instead of metal. But these evolving practices were not developed by comparing the effects of one application to the next. The fundamental practice is the same: an ancient, mystical legacy borne from a theory of medicine developed before the Chinese were culturally permitted to dissect cadavers and learn the inner geography of the human body.
Every culture on the planet has classical theories of medicine which grew from antiquated understandings of the human body and the nature of disease. In the west, we practiced a system of medicine called humorism, which presumed that diseases occurred from an imbalance of four bodily fluids, or “four humors” - yellow bile, black bile, blood, and phlegm. This classical theory of medicine led to treatments such as bloodletting, an attempt to re-balance the humors by bleeding an ill person, or emetics to induce vomiting. These ill-informed rituals caused countless deaths and needless suffering. In the 19th century, humorism was replaced with the empirical model of medicine we use today.
Even in China, acupuncture has gone through cycles of popularity and disfavor. Its use began declining in the 12th century, and by the early 20th century the practice had been almost completely discontinued. It was revived by Chairman Mao Zedong out of practical necessity - with fewer than 30,000 trained physicians in all of China, the Chinese government was under intense pressure to serve a massive population in great need of medical care. Despite his public endorsement of Chinese medicine, Mao himself did not believe in it and preferred western medicine himself.
Now, in the 21st century, we are still observing a resurgence in demand for acupuncture and other alternative treatments. In the early 1990s, less than one percent of the US population had used acupuncture, but that number is rising quickly. Much anecdotal evidence and thousands of testimonials claim that acupuncture does work to treat a wide variety of ailments, but western medical practitioners are still hesitant to endorse the practice.
Western practitioners’ skepticism may be due to acupuncture generally failing to demonstrate clinical effectiveness in rigorously controlled studies and meta-analyses. ‘Real’ acupuncture does not outperform ‘sham’ acupuncture (a placebo ritual where the acupuncture needles do not actually pierce the skin) in clinical trials. This suggests that the benefits patients receive from acupuncture come from the ritual rather than the needling or piercing itself. Acupuncture may reduce pain and symptoms by informing the expectations of the patient, taking advantage of classical conditioning, and providing a positive and warm effect from the practitioner. Some studies have even found that acupuncture - real or sham - can improve pregnancy rates when used in conjunction with in-vitro fertilization. The placebo effect can be strong and should not be underestimated - a caring, attentive acupuncturist may do far more good for the patient than a brusque doctor pushing pills, even if the needling itself is completely inert.
Extraordinary as the placebo effect is, it does come with one caveat - for the effect to work, the patient must be unaware that they are receiving a placebo. They must believe they are using an active medicine or an effective practice and their brain does all the rest. However, therein lies a vexing moral conundrum for doctors, educators, and companies like us who are torn between the desire to help people and the desire to promote truth. Unfortunately, placebos begin to lose their efficacy if the patient knows that the treatment is a placebo. Is it ethical to sell placebos under the pretense they aren’t placebos? Does the potential benefit of the placebo to the individual outweigh the cost of the lie?
Even amongst our team we hold many differing opinions on this issue, but we chose to open this discussion because our mission is to empower women through a better understanding of their health and bodies. This includes promoting full disclosure in regards to medical treatments that we have commented on, and any other information we reference that may affect the choices women make relating to their health. The intent of this post is not to push any particular agenda but that of providing information and education, and we hope for our readers to use us as a resource to make informed decisions about the health of their bodies and minds, and to choose what is ultimately best for themselves.