There Is No Sham In Acupuncture




The randomized controlled trial (RCT) is the gold standard for evaluating whether or not a therapeutic modality works. In RCTs testing the effect of acupuncture to improve symptoms, researchers often use “sham acupuncture” as a control procedure, on the theory that sticking needles into points that are not on acupuncture meridians should have no effect.

The problem with this approach is that there is really no such thing as sham acupuncture.

In the mechanistic, Western view of the body and medicine, acupuncture is the sum of the parts, so it works like this:

problem + needle + point on meridian = problem gets better

AcupunctureYou can insert other things in place of “needle + point on meridian” and you’ll still have an accurate model for Western medicine.

problem + medication = problem gets better
problem + surgery = problem gets better

Each of these focuses on a specific functional or anatomic mechanism for ill health. High blood pressure? Take a beta blocker. Blocked coronary arteries? Replace them with femoral veins (better yet, internal mammary arteries).

In this view, placebos make perfect sense as a way of proving that interventions work:

problem + thing that looks like medication but isn’t = problem doesn’t get better

Here’s where the mechanistic view of the body and how medicine works fails to meet the holistic view. Acupuncture can’t be shoved into the mechanistic “if A, then B” box of randomized, controlled trials.

Solid evidence is emerging that the effects of acupuncture are mediated through the limbic-paralimbic-neocortical network. It plays a central role in the affective and cognitive dimensions of pain–and in regulating and integrating emotion, memory processing, autonomic, endocrine, immunological, and sensorimotor functions.

For instance, a recent study using functional MRI of the brain to trace the effects of acupuncture in the brain stimulated four points: Taichong (LV3), Xingjian (LV2), Neiting (ST44), and a sham point on the top of the left foot. The hemodynamic response was similar for all four points, as was the sensory experience as reported by the study subjects. Regardless of the point being needled, acupuncture produced extensive deactivation of the limbic-paralimbic-neocortical system.

In short, there is no such thing as sham acupuncture. Because the cognitive, affective, and physical intertwine in the limbic-paralimbic-neocortical network, there’s no way to have a needle stuck into you without experiencing at least some of the effects of acupuncture.

You might think that this would be good news for proponents of acupuncture. One way to interpret this information is that acupuncture is such a robust modality, it’s effective even when used outside traditional guidelines.

However this probably won’t come as a great surprise–from the Western perspective, interventions remain suspect if they can’t be isolated and controlled for. Even as acupuncture gains a toehold in Western medicine, it’s unlikely to ever be fully accepted as a treatment modality.

Reference

Fang, J., Jin, Z., Wang, Y., Li, K., Kong, J., Nixon, E.E., Zeng, Y., Ren, Y., Tong, H., Wang, Y., Wang, P., Hui, K.K. (2008). The salient characteristics of the central effects of acupuncture needling: Limbic-paralimbic-neocortical network modulation. Human Brain Mapping DOI: 10.1002/hbm.20583

  • Mitch Harden

    I saw a recent article: http://www.sciencedirect.com/science/article/pii/S0031938407003514?via=ihub that used Sham electroacupuncture in rats with decent results. But do the meridians translate well from a bipedal primate to a quadrupedal rodent?

  • http://www.skepdic.com Bob Carroll

    There is a better sham acupuncture that involves using a device so that neither the experimental nor the control group knows they are getting stuck with a needle. The contrls do not get stuck at all. Yet, they get as much relief from pain as the ones who get stuck. Since this is not a placebo and not to be explained mechanistically, I guess the intention and belief of the patient direct the process. We should be able to get the same results just thinking about getting acupuncture. What a wonderful thing the mind is! Who needs evidence when we’ve got happy thoughts and healthy beliefs?

  • http://wellbeingandhealth.net/ Evan

    So if we think about the points does the MRI look the same?

    None of this explains how points nearby give different results. Or how combinations of points give particular results.

    We need to go well beyond pain relief.

    Evan

  • http://acupuncture.vitalis.co.nz/ Acupuncturist

    An interesting point of view.

    There are FMRI acupuncture studies which prove just the opposite!

  • http://www.realityshifter.com Kristen

    By describing how acupuncture can trigger the same results regardless of where the needles are placed, haven’t you done more to prove the involvement of the placebo effect than to disprove it? If the modality of acupuncture is defined as “the placement of needles along specific meridians to trigger such-and-such results”, how does it view the placing of needles elsewhere? Is that considered “not true acupuncture” by the standards of practitioners of the modality?

    You can’t define acupuncture as one thing, do something different, and then claim it’s because acupuncture works “regardless of how it’s done”. You have to define acupuncture as a specific set of steps performed in a specific way and then prove that performing those steps in that specific way is what triggers the results. That’s the whole point of the scientific method.

    In your article above, you’ve essentially proven that acupuncture of any kind functions solely via the placebo effect — i.e., the power of the mind is what ultimately triggers the results, not the placement of needles in the body.

    Please note, I’m not trying to dispute the effectiveness of acupunture. I’m just trying to show how people in various alternative health fields often criticize Western science methods but then try to twist those same methods to prove the validity of an alternative treatment. In the end, they don’t end up helping their cause. Either apply the scientific method in a legitimate manner or not at all.

  • http://wellbeingandhealth.net/ Evan

    Well said, Kristen.

  • http://acupuncture.vitalis.co.nz/ Acupuncturist

    I wasn’t clear in my previous comment. *There are* studies on acupuncture and FMRI which show that specific acupuncture points *do cause* specific response.

    Furthermore, there are studies which show that acupuncture does have other specific physiological effects like increasing uterine blood flow (this one was also done on rats and rabbits, not sure if you can make them think about acupuncture points to induce that effect).

    However, Jennifer is right, as you do get physiological response even if the needle is not inserted into acupuncture point (which is, by the way, a valid and acupuncture technique). This can make controlled trials a little more challenging.

  • http://www.einklang.com Thomas

    I agree with Kristen, who wrote so well.
    Being a German acupuncturist with 25 years clnical experience in Japan I cannot help but “stumble” when I come across the phrase “true acupuncture”. In most materials I have seen so far, this refers to “Chinese acupuncture”, which is often rather painful. In Japanese acupuncture people often do not feel the real needles at all – which means they cannot differentiate between real acupuncture (being needled) or sham acupuncture (not being needled). Still the effect is usually quite clear.
    Since I am not a scholar, I prefer not to go into any further detail, but I tend to support the articles notion: the effects of acupuncture are a mixture of the real physical stimulation plus a personal interaction with the patient resulting in a sort of multimedia effect, that cannot be properly reduced to a simple A+B=C, a tendency of reductionist science.
    I love science and enthusiastically support most of its research, but I am also convinced, that current methods, the “gold standard(s)” mentioned in the artical above, is not the right tool for the job to be done. (I believe engineer Scott from the starship Enterprise would support my view … just joking)
    Greetings from the very hot Japan

Jennifer Green, MS

Jennifer Green, MS, is a freelance health care writer. A former nurse and college professor, she now writes about health care for clients around the world. She's particularly interested in research into the mind-body connection.
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