The point is, does acupuncture work?

JOE SCHWARCZ
Freelance

http://www.canada.com/montreal/montrealgazette/columnists/story.html?
id=456f62bb-cf50-47c1-b20e-18703c0d5675


Sunday, May 02, 2004





The rat didn't squirm much as the needles were carefully inserted.
There was no pain. With stopwatch in hand, the researcher then
focused a heat gun on the animal's rear and carefully noted the time
required for the tail to "flick" by reflex action. Other rats, some
needled and some not, were subjected to the same procedure. The
conclusion was that acupuncture significantly delayed the onset of
pain!

Proponents of acupuncture often quote this study as proof that the
2,000- year-old Chinese technique of jabbing needles into the body
to treat medical conditions has a scientific basis. After all, they
claim, the effect cannot be in the rats' mind, as they have none.
But a rat is not a miniature person. So what's the story about
acupuncture for humans? Let's take a stab at that question. But
first, a bit of history.

The western world was alerted to the practice of acupuncture in 1972
when then-U.S. president Richard Nixon visited China. A New York
Times reporter accompanying the president had to undergo an
emergency appendectomy and received acupuncture therapy for post-
operative pain. He was so impressed by the unusual nature of this
treatment that he related his experience in the Times.

The story then took on a life of its own and rumours mounted upon
rumours.

"Did you hear about the guy who had his appendix removed in China
without any anesthetic?" buzzed the incredulous. "Those clever
Chinese just stuck a few needles into him and he felt nothing!" But
the truth was that the surgery had been carried out with regular
anesthesia, and acupuncture had only been used in an attempt to dull
the reporter's pain after the operation.

Nevertheless, the public's appetite was whetted by the notion of
such an apparently simple solution to pain. An Acupuncture Study
Group, including many notable physicians and researchers, was
assembled by the government to study the Chinese experience with the
technique. In 1974, off they went to the mysterious east to learn
how to rid U.S. pain sufferers of reliance on pain- killing
medications.

What they found in China did not exactly live up to the advance
billing. Acupuncture, as it turned out, was not widely used as an
anesthetic procedure. Even when it was used, it was almost always in
combination with barbiturate-type sedatives and the pain killer
demerol. The glorification of acupuncture, it seems, was based less
on science and more on Maoist propaganda designed to fuel the
Cultural Revolution and justify a reduced reliance on western
medicine.

The U.S. doctors investigating the Chinese claims discovered that
the claimed benefits for acupuncture were highly suspect.
Parkinson's disease patients who were being rehabilitated with
acupuncture showed no objective improvement. Neither did patients
being treated for deafness or head injuries. But just the fact that
U.S. physicians were seriously examining acupuncture caused a flurry
of interest back home and soon half-baked acupuncturists were
cropping up everywhere, treating every conceivable disease. The
zanier ones were "curing" conditions ranging from multiple chemical
sensitivity in humans to listlessness in goldfish and neuroses in
birds. The most amusing spin-off was "Earth acupuncture," which
involves hammering wooden stakes into the ground to make the soil
more fertile by "altering the Earth's natural flow of energy." I
think the only fertile thing here is the imagination of the
proponents of "Earth acupuncture." Which brings up an interesting
question. What role does the imagination play in the use of
acupuncture to treat disease?

According to the traditional Chinese view, the mind is not involved.
Health is based upon yin and yang, opposite forces in the body that
must be in balance to maintain health. When yin-yang disharmony
occurs, balance can be restored by stimulating channels in the body
called "meridians," which supposedly serve as energy conduits to
various organs. Acupuncture points are said to lie along these
meridians. This explanation, however, cannot be supported by
anatomy. There are no identifiable meridians in the human body.
Still, the fact that the explanation may be incorrect does not
negate the possibility that acupuncture can deliver the goods. The
only way to determine if it really works is through controlled
studies.

"Placebo control" is the gold standard for modern clinical trials.
We know that people respond to sugar pills and even to fake surgery
roughly 40 per cent of the time, an effect that must be taken into
account if a study is to be reliable. Designing a placebo-controlled
trial of acupuncture, though, presents some obvious problems. What
do you use for a placebo? Researchers at Heidelberg University in
Germany have come up with a very clever idea. They designed a device
that could be used in a "sham acupuncture" procedure. Essentially,
the idea is modeled on the classic "collapsing knife" effect used on
the stage.

The blade is gimmicked to retract into the handle as the victim is
stabbed, creating the illusion that the knife has plunged into the
flesh to the hilt. Similarly, the sham acupuncture device is
equipped with a needle that contacts the skin and then moves up into
the handle as the device continues its forward motion. It seems as
if the needle has been inserted into the skin.

Testing on volunteers revealed they did not suspect that there had
been no penetration. Now the researchers were ready to test whether
acupuncture was more than a placebo effect. They waited for the
results with bated breath. Just like you will have to do until next
week. I trust the wait will not be too painful.

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Joe Schwarcz is director of McGill University's Office for Science
and Society (www.OSS.McGill.ca). He can be heard every Sunday from 3-
4 p.m. on CJAD. joe.schwarcz@...