I’ve finally gotten around to reading Edzard Ernst and Simon Singh‘s book Trick or Treatment: The undeniable facts about alternative medicine. There are explanatory chapters, and reference summaries at the end, but the four treatments looked at in detail are acupuncture, homeopathy, chiropractic, and herbal medicine. Really, out of the four, homeopathy is the only one I have a definite (and derisory) view on. Acupuncture intrigues me, something about it to me seems strangely intuitive, but of course I’d never make any proclamations until I’d really looked into it. So, with relish I delved into alternative medicine chapter one.
Acupuncture probably (although not certainly!) has its roots in China, and is generally understood in terms of the balance of the life force Ch’i. Tapping into specific meridians in the body releases and redistributes Ch’i, curing what ails you. As with many alternative therapies, acupuncturists today claim to be able to treat a wide range of diseases, from dry eyes and hair loss, to toothache and tendinitis. Most of the problems, however, revolve around pain and nausea.
Ernst and Singh move through the history of acupuncture to its revival (in both the East and West) in the latter half of the 20th Century. Miraculous claims came from visitors to China, and it swept through the US. It wasn’t long before people started to question, and test, those claims. A large number of trials were conducted in the 1970s, of extremely variable quality, which led a group of WHO panellists (many with vested interest) to conclude acupuncture did seem to have helpful properties for a range of conditions. Another report in 2003 had similar glowing reviews of certain acupuncture treatments.
But how much of this was due to the placebo effect? Not all studies were appropriately blinded, or double-blinded, the latter of which is nearly impossible for acupuncture trials. A fake acupuncture needle that creates the same sensation, for both the patient and doctor, is a big task (although Ernst details how his lab has made some advancements in creating retractable needles). Unimpressed by the uncritical inclusion of all studies in the WHO examination, acupuncture has since been subject to a Cochrane Collaboration review: a way of considering each study’s merit when assigning them weight in the final conclusion.
The Cochrane review had much weaker conclusions than the WHO reports. Many previously reported positive effects failed to emerge, and much confidence was downgraded. However, for a certain class of pain and nausea conditions, the Cochrane review was cautiously optimistic.
So, do Ernst and Singh conclude acupuncture may have some benefits? With cautious conclusions, the answer is, of course, more research is needed. Using new “sham” needles, such as those developed by Ernst and his team, several “mega-trials” have been conducted across Europe. The preliminary results of these trials (as of 2008, when the book was published), indicate real acupuncture performs as well or only marginally better than sham acupuncture for those conditions left with some hope after the Cochrane review.
The authors conclude with this intriguing sentiment: “The trend continues – as the trials become increasingly rigorous and more reliable, acupuncture increasingly looks as if it is nothing more than a placebo.”
It seems then, they expect acupuncture will lack scientific proof. Of course, like any good scientist, this doesn’t mean they’ve made up their minds before all the necessary “more research” is done. But if they were betting men, well, you might guess where they would place their chips.
Then I found this: a feature in this month’s The Scientist about the “Science of Stretch” – in particular, the impact of tensing connective tissue in the body as a way of relieving pain. Researcher Helene Langevin details her journey through investigating the oft-neglected importance of connective tissue that enshrines our body and outlines its structure. She provides a possible mechanism for acupuncture to work: fibroblasts (cells that synthesize collagen) respond to sustained stretching by changing shape, leading to large-scale relaxation of connective tissue. Twisting acupuncture needles grip the connective tissue and provide this sort of stretching.
Langevin also acknowledges that more research is needed, especially as connective tissue is under-studied, and 2-D and 3-D experiments differ considerably. But she concludes with a rather interesting paragraph:
“By default, alternative medicine has become a motivating force in connective-tissue research and clinical practice. This is an example of an area in which the combination of conventional and alternative medicine, typically referred to as “integrative medicine,” should be understood in a broader sense as integration within medicine itself, inspired by alternative-medicine concepts. The growth and maturation of the field of connective-tissue research will no doubt benefit from exciting new developments resulting from this integration.”
Sometimes, we forget that alternative medicine research goes on (and I must point out, Edzard Ernst was a part of it). While many practitioners and overzealous supporters keep spinning the same lines about Ch’i and energies, there are curious researchers delving deeper for a physiological explanation. And that could be of benefit to us all.
It may turn out that acupuncture really is just a placebo. But that raises the age-old question: even if it’s just a placebo, isn’t any relief good relief? The authors promise to bring it up again in later chapters, as do I when I read them!