By Roy Benaroch, M.D., Emory University
Acupuncture is both an ancient Chinese treatment and, like a lot of Eastern medicine, a recent Western trend. But does acupuncture work as a remedy for pain? Let’s look to legitimate medical trials to find the answer to that question.
The History of Acupuncture
Traditional acupuncture was developed in China, certainly by the 1st century before the Common Era, and likely well before that. Classically, the mechanism of acupuncture is thought to adjust the flow of vital energy or life force, called qi, through various conduits or meridians in the body.
In China, as dissections were forbidden, these theories developed without any knowledge of anatomy. Interest in acupuncture waned in China by the 17th century, when it was deemed irrational and superstitious. However, it was officially reinstated along with many other methods of traditional Chinese healing in 1949 at the close of the Chinese civil war.
The traditional theories of acupuncture have been challenged, especially by acupuncturists in the West, where the ideas of the flow of qi and meridians have been replaced by many different neurologic theories.
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Rating the Efficacy of Acupuncture
Does acupuncture objectively work, and is the media accurately portraying the state of the science?
Let’s focus on two acupuncture studies widely reported in the media. The first was from 2017, published in the Medical Journal of Australia, titled “Acupuncture for Analgesia in the Emergency Department: A Multicentre, Randomised, Equivalence and Non-Inferiority Trial.”
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This was a big trial, involving four hospitals in Australia, randomizing over 500 adults with back pain, ankle sprains, or migraines to either acupuncture alone, medications alone, or a combination of the two. Unfortunately, the patients themselves weren’t blinded to what group they were in, which could have biased the results.
What the authors found was that the relief of pain was about equal between the three groups, and what they concluded was that “The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy.”
But, dig deeper into that study, and there are some big problems. The biggest is that all three groups, no matter how they were randomized, were allowed to get a dose of rescue pain medication.
The acupuncture patients got three times as much rescue medicine as the people in the medication-only group. In other words, the patients randomized to acupuncture got medicine, anyway.
In all of the groups, adequate pain relief was reached only 16 percent of the time.
The correct conclusion of this study was that patients didn’t receive good pain relief in these emergency departments, whatever was done. It does not support the idea that acupuncture was effective.
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How the Press Misrepresented Acupuncture Studies
But that’s not how the press reported this study. The authors claimed it worked, and the media ran with that angle with headlines like “Acupuncture May Be Effective Painkiller in ER” from Philadelphia’s The Inquirer newspaper.
Even science-oriented outlets parroted the acupuncture-works message, like Science Daily’s “Acupuncture Relieves Pain in Emergency Patients.”
Although skeptical bloggers were quick to post in-depth analyses that came to very different conclusions about this study, for the most part, the mainstream media reported only the positive findings, without caveats, and without a critical assessment of what the study actually showed.
Another acupuncture study made positive headlines that year, about using acupuncture to treat colic in babies. Headlines included “The Soothing Benefit of Acupuncture for Babies,” from Time magazine.
However, the study reviewed failed to show a statistical improvement in the primary endpoint. When a study is designed, there is usually one primary endpoint—the main finding that’s being measured.
In the colic study, the primary endpoint was the measured amount of total time that the babies were crying. The study didn’t find any difference in this endpoint between the study groups given acupuncture or not given acupuncture.
But, the authors claimed to show that some of the secondary endpoints showed a positive effect from acupuncture. They applied 24 different secondary statistical tests to the same data, looking at data subsets and different ways of slicing the pie, so to speak, and found three of those 24 alternative ways did show a difference.
This method of massaging the data and reanalyzing it until you get the result you’re looking for is called “p-hacking”. Editors and journalists shouldn’t be fooled by such trickery. This acupuncture study showed quite clearly that acupuncture was not more effective than placebo for the treatment of colic.
A More Balanced Perspective on Acupuncture
Not all of the news outlets who covered this story were as fawning and positive as the Times story. In contrast, the BBC reported under the headline “Can Acupuncture Ease Baby Colic?”
The article said, “The crying of babies with colic may be reduced if they are treated with acupuncture, according to controversial research from Sweden. But UK experts say no conclusions can be drawn from the small study of 147 babies…”
The BBC article goes on to detail the study’s shortcomings, and why the results should be considered controversial.
What accounts for the difference in approaches? The Time article relies on quotes from one of the study’s authors, plus an alternative-health-oriented physician who offers only praise for the study without any kind of critical assessment.
Other news outlets often relied on sources outside of the alternative-health community and were able to highlight a different point of view.
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The Media’s Role in Reporting on Alternative Health Studies
A thorough news report should try to present a viewpoint from scientists not directly involved in the study, or from people with genuine expertise who can offer a balanced viewpoint. Both sides of the scale should be represented, not just the study authors.
Watch out for that when assessing health news stories. Consider who is being quoted and whether they are genuine experts in the field. Are they likely to be biased in one direction or another?
Beware of this, too: the problem of so-called “false balance” in medical reporting. News stories ought to be balanced, providing different points of view on social and political matters; and even in the world of science, many issues are not firmly settled.
But that doesn’t mean that all sides should have equal weight. Controversy may be interesting, as it may attract readers and mouse-clicks to stories, but scientifically invalid or blatantly false assertions should not be given equal weight to what a vast and established scientific consensus shows.
So what should the media’s role be when looking at the world of alternative medicine? The answer is to treat stories about alternative medicine with the same rigor as they should treat any other medical story.
Get the facts right, interview the experts, and don’t create a false impression based on biased opinions or salesmanship. Some promising stories can genuinely help people, but sometimes those get mixed up with clickbait.
What we as consumers need from medical journalism is an honest assessment, even when that means a new medicine, herbal product, or diet just didn’t work. To paraphrase Colonel Jessup in A Few Good Men, you can handle the truth.
Common Questions About Acupuncture
Acupuncture has long been studied due to its effectiveness for many conditions. There are no scientific explanations or proof of meridians or acupuncture points, and yet it often works.
Some people have reported light-headedness, dizziness, or skin rashes, but the primary side effect of acupuncture is irritation and bleeding from the needles used in the treatment.
The actual clinical time required for the acupuncture treatment typically only takes around 30 minutes.
Very few deaths have been reported from acupuncture treatments, with only around 90 on record. Most of these were the result of the needles hitting vital organs.