There Is No Sham In Acupunctureby Jennifer Green, MS | July 29, 2008
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
You 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.
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
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