The Truth of “Sham” or “Fake” Acupuncture in Pain Management Trials: An Emergency Medicine Doctor's Viewpoint

In today's standardized acupuncture (known as TCM in the West), there are 361 acupoints precisely and “accurately” located on the 14 1-mm-wide straight or curved lines called meridians. These acupoints are deemed as the most indispensable foundation stone upon which all remedial formula of Chinese medicine have been developed.

Acupuncture Tested against Sham Acupuncture

Since late 1990s, biomedical community worldwide started to test TCM acupuncture using randomized controlled trials (RCT). In 2001 – 2005, a large trial (n=1,162) was conducted in Germany. The trial demonstrated that for lower back pain and knee pain, effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy (a combination of medication, physiotherapy and exercise). With low back pain and knee pain pooled together, treatment success (a reduction of the WOMAC score by 36% or more) occurred in 53.1% of the verum group, 51.0% of the sham group, and 29.1% of the conventional therapy group.

In 2009, a meta-analysis of 13 trials (3,025 patients) was conducted in Copenhagen, comparing sham and real acupuncture. The authors reported in British Medical Journal: "A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. "

In 2012, another meta-analysis led by American researcher Andrew Vickers of the Memorial Sloan-Kettering Cancer Centre, New York, was published in Archives of Internal Medicine. It looked at 29 randomised control trials involving 17,922 patients treated for chronic pain. Again, real acupuncture was slightly better than sham treatment, while acupuncture was moderately better than no acupuncture.

How is sham acupuncture performed? As reported in the trial conducted in Germany, in sham group, needles are inserted in randomly selected points instead of the points selected based on TCM acupuncture theories (meridians, yin-yang – 5 elements …).

Skeptics' Voice: Acupuncture No More Than A Placebo

In 2013, two leading medical rationalists, pharmacologist David Colquhoun and neurologist Steven Novella, stuck in the knife: "the benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance. It seems that acupuncture is little or no more than a theatrical placebo." (Anesthesia and Analgesia, 2013)

Is Sham Acupuncture Really A “Sham”?

In response to the skepticism, Daniel Keown, a Britain Emergency Medical doctor (MCEM) and also a licensed acupuncturist, provided his point of view. In his book (The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine), he wrote:

“Sham points don’t exist – there are strong points and weak points. What you are measuring with ‘sham Acupuncture’ is more like ‘non-specific Acupuncture’.

“When a large German trial showed that Acupuncture was more effective than physiotherapy in chronic back pain, the detractors cried loudest: ‘But the sham Acupuncture worked almost as well!’

“Well, that’s because it’s still Acupuncture, isn’t it?!”

Dr Keown is right. The sham acupuncture in the Germany trial was not a sham but still real acupuncture – needles penetrated into skin. The truth is, acupuncture or even the acupuncture-like modalities (press the skin or warm up the skin without needles) really works, more or less (with efficacy from 0.001% specific to 100% specific), and whether you stimulate the meridian points (standardized in TCM system) or non-meridians points is irrelevant.

The reason that there was no difference between "sham" acupuncture and the real acupuncture in those trials is that the real [TCM] acupuncture points used in the trials are no more specific in efficacy than the randomly selected ones.

The Root Cause of Skepticism

As a needle healer myself, I don't blame the two scientifically-minded skeptic scholars, rather I appreciate their candid voice which helped me in deepening my critical thinking. Indeed, I'm unable to deny the facts that thousands of trials done in the last few decades constantly demonstrated the “sham” or “fake” acupuncture works as good as the real ones (today's standardized acupuncture). In addition, I am not capable to persuade them to believe the standardized theories underpinning today's standardized acupuncture that there is an “energy or Qi” flow in “meridians” which, if blocked, will induce diseases.

The root cause of skepticism over acupuncture lies in the history that got things wrong and has kept almost everyone misled in the last 2000 years (Clarification of how this misleading happened is the purpose of this Newsletter).

How to Discover The Science of Acupuncture?

“There is a science of Acupuncture, but in order to discover it we need to be scientific, “ Dr Keown continues. “ Acupuncturists need to embrace anatomy and physiology, stem cells and genetics, bio-energy and electromagnetism, but we need to do it with intelligence.

“Too many Acupuncturists are woolly minded and unquestioning, and too many [Western medicine] doctors are pigheaded and arrogant.

“Ignoring 5000 years of medical tradition and healing because you don’t understand it is not being scientific, it is being stupid and ignorant. Likewise, blindly following 5000 years of tradition because you don’t have a curious and sceptical mind is bound to send you up a blind alley.”

Ancient wisdom We Must Build on

“The classics were written to pass down information through turbulent primitive times. It is testament to their power and truth how well they have succeeded.

“Now we must build on them…”, Dr Keown concluded.

Epilogue

My writing of this Newsletter – Truth of Acupuncture Science: How A Jewel Ended up A Quackish Stone in Acupuncture History - would not have been possible without the constant inspiration from tons of great works by numerous scientifically-minded people including many medical rationalist skeptics. Among these people, there is Dr Daniel Keown, a Britain Emergency Medical doctor (MCEM), a licensed acupuncturist, and a member of the British Acupuncture Council. He is also the author of the book The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine.

References

Daniel Keown, 2014.The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine.

David Derbyshire, 2013, Why acupuncture is giving sceptics the needle, www.thegardian.com

Haake, M. et al, German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups, Arch Intern Med, 2007 Sep 24;167(17):1892-8

#acupuncture #painmanagement #shamacupuncture #evidence-based #painscience