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Tuesday, July 23, 2013

Acupuncture for the beginning Skeptic.

Hello everyone, I hope that things have been going well.  It looks like things may be a little chaotic here at the Skeptical Okie Headquarters for a while.  While trolling some of the odder sites on the internet (no, not those sites), I came across a really weird article (dare I say misguided or blatantly wrong?) on Conservapedia.  Basically, it says that "Dinosaur skin discovery befuddle evolutionists.  Why?  The earth is only 6000 years old."  Urg!  I go on some of these sites for a laugh, but I have a strong interest in paleontology, so this really irked me.  I have been fighting the urge to write them and ask if they aren't really a front for The Onion.   You know, stories that they thought were too out there to put up on their own site.  Besides, who the hell really uses the word befuddle anymore.  But in the mean time, I am going to continue the Topics for Beginners series, which I hope has been helpful so far.  The reason I started with homeopathy is that it is more than likely one of the first of the pseudosciences that you will come across as you begin this wonderful, and at times stressful journey into the skeptical movement.

Now for a fun little thought trip.  You've noticed that lately you've been having asthma problems.  You call and make an appointment, and show up in a very cute little office.  You sit back, read the magazines, and finally get called into the exam room.  You sit down and tell the nice person your problems, and wait for their diagnosis.  They tell you that obviously you have blocked or disturbed chi, but they have just the thing.  They have you lay on a table, close your eyes, and tell you you might feel a little prick.  They then proceed to put anywhere from 15 to 100 very thin needles in various places.  At this point, they may ask you how you are feeling.  To be honest, if you are in a confined space with someone that basically just stabbed you with needles, are you going to tell them you feel worse?  This folks, is acupuncture (the key part of the word is puncture) and this:

is what you may look like.  Oops, sorry, wrong picture.  I meant this is what you might look like


(photo from acupuncturehoustoncity.com)

The basic breakdown of acupuncture is that it is a cross between acupressure points and a porcupine.  The practitioners have various charts that display where to place the very thin needles to help clear any blocked chi, usually along what is called a meridian line.  These are supposedly lines that travel the body and help the chi (usually pronounced key or chee) move throughout the body.  Just like with many other new age medical treatments, there are traditionalists and contemporary practitioners that have competing ideas concerning the placement of the needles and even the materials that they should be made of.  Before I devolve into a rant against untested, unfounded, and even dangerous pseudo-scientific bullshit, let's talk a bit about the history of acupuncture, shall we.

History:
The history of acupuncture is, of course, a little murky.  According to the RationalWiki, it dates back to about 300 BCE, while Wikipedia places its roots at possibly 1600-1100 BCE.  Acupuncture.com has the date roughly between 480-221 BCE for the beginning of acupuncture, but the wording of the article makes it a little difficult to be sure. According to them in another article, it may even go back as far as 4700 BCE.   In an article about the history of acupuncture, it seems to deal mostly with the political and philosophical development of China.  Conservapedia has a 2 sentence blurb, and yet they manage to make it sound as though it has been definitively proven to work.  Everyone does agree (except Conservapedia, which doesn't even mention it's origins) that it began in China a long time ago.  Most of the proponents for acupuncture will use this as a basis for their arguments concerning the efficacy if their treatments.  This is the logical fallacy known as "The Argument from Antiquity".   In this fallacy, you are stating that the concept is correct or it works because it's been around for a long time.   You can also call it the "Time tested appeal"  This is an argument used by many people that either use or practice alt-med.  They are saying that because the advancement of science hasn't completely eliminated their ideas, they must be onto something that modern medicine has missed, like chi, qi, chakras, meridians, etc.  You know, things that scientists don't understand because they can't be disproven or tested, (even though they have been many times) so they must be there and we just can't find them.  What is known concerning the history of acupuncture (and I am personally going to go with the 300 BCE figure due to several factors such as metallurgy and known written texts) is that it has been an aspect of Chinese health care for at least 2000 years.

Theory:
The theory behind acupuncture is actually rather intriguing.  It also sounds sort of like the ideas that the medieval european  healers had concerning illness.  From Acupuncture.com

As the basis of Acupuncture, Shen Nung theorized that the body had an energy force running throughout it. This energy force is known as Qi(roughly pronounced Chee). The Qi consists of all essential life activities which include the spiritual, emotional, mental and the physical aspects of life. A person's health is influenced by the flow of Qi in the body, in combination with the universal forces of Yin and Yang . (I will discuss Yin and Yang a little later). If the flow of Qi is insufficient, unbalanced or interrupted, Yin and Yang become unbalanced, and illness may occur. Qi travels throughout the body along "Meridians" or special pathways. The Meridians, (or Channels), are the same on both sides of the body (paired). There are fourteen main meridians running vertically up and down the surface of the body. Out of these, there are twelve organ Meridians in each half of the body (remember they are in pairs). There are also two unpaired midline Meridians.

(and no, I'm not linking to these people.  I view them to be nearly as bad a naturalnews, and I don't really want to be associated with them in anyway, except discussing their articles.)  Every article I've read says that there are either 12 or 14 meridian lines running through the body.  Why they can't agree, I really have no idea.  From RationalWiki you get :
Its theoretical basis is that health and sickness are caused by the good or bad flow of chi through the body, in particular along the twelve major meridians of the body (though some authorities list fourteen or even more) which run from head to toe along the body, and which are associated with the bladder, gallbladder, heart, large intestine, small intestine, kidneys, liver, lungs, spleen, stomach, pericardium, and "triple heater". It is necessary to translate this last term word for word from the Chinese because there is no such thing as the "triple heater".
The acupuncturist treats the ailments of these various parts by inserting needles at points lying on these meridians, known simply as "acupuncture points" and manipulating the needles to increase or decrease the flow of chi along that meridian.

So basically the idea behind acupuncture is "something's wrong with this person, let's jab a bunch of needles in them and see what happens."  I can only imagine the testing and trials they went through.  It probably went something like "You feel bad?  OK, lay down.  Um.... I know, tell me if this makes you feel better.   No?  How about when I put it here.  OK.....uh, that went badly.  Mental note, don't go very deep, especially there.   But, he doesn't feel bad anymore.  Next patient please."  I know that was sarcastic and a little goofy ( and I would love to see a Monty Python sketch based on the origins of acupuncture) but in all honesty, that may be close to what happened.  The thing is, no one knows how it came about.  Aside from the needles, the other basic premise of acupuncture is chi (this is the spelling I'm going to use for the rest of the article).  Chi is a persons life force.  And used to make the spirit bomb in Dragonball Z.  When it the balance of chi is altered, either by being concentrated or blocked in an area, illness occurs.  To help alleviate the problem, the flow of chi must be returned to proper levels.  An acupuncturist uses a chart based on acupressure points, which I'll discuss in a bit, to determine the best location to place the needles to help restore the flow.  Once placed and manipulated by the practitioner, I imagine it's like clearing a dam in a river.   Some practitioners also claim that the 5 elements are involved.  I don't mean carbon, nitrogen, hydrogen, oxygen, and copper.  I mean earth, wind, fire, water, and spirit (Go Planet!)  These forces need to be in balance with each other in order to preserve health.  If one comes to dominate the others, or one is entirely depleted, then illness will occur.  These forces can also be manipulated using acupuncture.  How you can manipulate air or fire with a metal needle, I have no idea.  I can't even begin to grasp how that would work.

Diseases:
Like any other alt-med practice, there are a wide range of diseases that acupuncturists claim to be able to treat.  From one article in Acupuncture.com:
The most common ailments currently being treated are: lower backache, Cervical Spondylosis, Condylitis, Arthritic Conditions, Headaches of all kinds (including migraine), Allergic Reactions, general and specific use for Analgesia (including surgery) and relief of muscles spasms. There have also been clinical trials in the use of Acupuncture in treating anxiety disorders and depression. Likewise, very high success rates have been found in treating addictions to alcohol, tobacco (nicotine) and "hard' drugs.Acupuncture can rid the body of the physical dependency, but can not rid the mind of the habit (psychological dependency). For this reason, Acupuncture treatment of addictions has not been fully successful.

And under the main pages Patients:Conditions A-Z you find :

 
They don't claim all can be treated with acupuncture, such as gum disease, but they also promote chinese herbal medicine, which is a form of naturopathy.  I'm not going into this right now because it is going to be a blog post in the near future.  However, the number of diseases they claim can be treated with needles in the dermal layer is appalling.  Especially given that there have been no definitive studies that show acupuncture actually works.

The Tools:
Lets go back to the little example in the beginning.  While laying on the table, listening some new age music that's piped into the room, the kindly person that claimed they could help you would be sticking these into your skin

Pleasant, aren't they.  These are the acupuncture needle.  When I googled for them, I actually found a large number of varieties.  This really doesn't sound like a heavily monitored industry.  And yes, it is an industry.  Proponents of alt-med will normally utter the phrase "Big Pharma" at some point in their argument.  Alt-med makes billions of dollars each year, just like the pharmaceutical companies.  As a matter of fact, some pharmaceutical companies, like Merck,  have actual bought or created their own alt-med lines. Back to the tools of the trade.  Another tool they use are the all important meridian and acupressure point charts.  Here is where it gets a little odd.  There are many charts that show a lot of different points.  There are roughly 670 points, according to Acupuncture.com.  RationalWiki doesn't have a total, but Wikipedia gives a range from 160 to 670, stating that part of the last number is due to a number of pressure points on the ear.  Some of the charts they use look like these:
I don't know how your ear controls what goes on in your feet.



I did find many more, but they aren't shy about showing the human body, and in case there are small children looking at this, I didn't want to cause them to hit puberty early.  They even have charts for animals.

There are also charts for dogs, cattle, and horses.  And I don't know about you, but having been around these animals for most of my life, I would not want to be the person trying to stick a needle in them.

Alternatives:
There are some alternatives, aside from the exact placement of the needles and what the placement actually does.  One of the most common is is electro acupuncture, which like so many other pseudoscience claims, has been promoted by Dr. Oz/  Electro acupuncture is acupuncture with an mild electric shock.  Many traditionalists do not consider this true acupuncture.  Another alternative is whether they use wooden or steel needles.  Most practitioners use surgical stainless steel, but some are making a move back to a more traditional treatment.  There is also a needle-less acupuncture.  This is a combination of faith healing (another future topic) or psychic surgery and acupressure points.  Much like homeopathy, people claim that the effects of acupuncture are so strong that needles aren't really needed. (15 cool points to the first person to leave a comment as to what more than likely causing this).  There is also a form called Sonopuncture, which uses ultrasound instead of  needles to manipulate acupressure points.  There are probably more forms that I haven't heard of or been able to find.

Problems:
Once again, people often ask "What's the harm?"  Outside of the normal risks that come from opting for alternative medicine to treat life threatening illnesses, there is at least one additional danger from using acupuncture.  Much like a real doctor or a tattoo parlor, sterilization is of utmost importance.  Over the years, there have been reports of people contracting diseases such as hepatitis C from contaminated needles and improper sterilization techniques.  This is a risk anytime you are dealing with something that can break your body's first line of defense, you skin.  Anytime you are dealing with a procedure that involves piercing the skin, you can demand to watch them open a new, sterile package before proceeding.  an uncommon, but not unheard of problem, is the acupuncturist going too deep with the needle and piercing something such as an organ and causing even more problems.  Another problem associated with acupuncture is the actual efficacy of the treatment.

Testing:
Looking on PubMed.gov, there are numerous studies concerning the efficacy of acupuncture.  For the most part, they seem to lean towards that it may effective in treating some of the symptoms, but not the actual disease.  The reason acupuncture may be at least partially effective in treating various symptoms such as pain, fear, soreness and the like is due to the release of dopamin and serotonin, which help with both mood and pain receptors in the body.  This is the same idea as the best way to cure a headache is to drop a hammer on your foot.  The main problem with testing acupuncture is that it is incredibly difficult to develop a true blinded test with a reliable control with acupuncture.  This is mostly because either the person placing the needles knows if they are doing it correctly, or the person receiving the acupuncture knows when a needle is sticking out of their skin.

Conclusion:
My conclusion is, if I wanted to have sharp objects jabbed into my skin, I would fight a porcupine.  It would likely have the same effect, but a much cooler story.  I don't feel that the available evidence proves that acupuncture is effective, and the risks can easily out-weigh the possible benefits.  Go in for headaches, come out with hepatitis, or at least a much lighter wallet.

I hope that this article is helpful for anyone that is just starting to look at the world in a skeptical manner.  I'm not saying that alt-meds don't work, I'm just saying that the current evidence doesn't show many of them to be effective. Thanks for reading, and until next time, be good, be reasonable, and be home in time for dinner.

The Skeptical Okie

6 comments:

  1. It is very informative post! Acupuncture originated in ancient China thousands of years ago and it is still used successfully today to treat medical conditions and to prevent sickness. Thanks.fertility acupuncture philadelphia

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    Replies
    1. Very interesting comment! What diseases is it guaranteed to prevent? Inquiring minds want to know!

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    2. I've been asking that for a long time. I think the only thing it will prevent is your wallet from getting obese.

      Delete
  2. Excellent post,thank you.
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