How to Research Acupuncture?
A problem with acupuncture is not so much the lack of research – there are kaboodles of it – but the way these researches are conducted. A recent online conversation I had with a fellow Xavier high school alumnus made this obvious to me. Here is a quote from an email I wrote which I think summarizes my thoughts on this.
Anyway here is the text:
(A) major misunderstanding (is) that the idea that acupuncture is like a pill – that can be single blinded (meaning that recipient doesn’t know that they’re getting the real thing or not) or double blinded (pill giver doesn’t know either.) Obviously, using fake needles or sham treatments would necessitate that the “treatment” giver NOt be blinded.
However, the first difficulty comes in designing an adequate “sham”
First objection: sometimes inserting needles anywhere seem to stimulate an effect as well.
Second objection: even just pretending to insert needles seems to have an effect. this is the “placebo” being indicated here.
The conclusion skeptics derive from these observations is thus: since inserting a needle into specific “points” doesn’t seem to be much different than inserting anywhere or simulating points without insertion, acupuncture is thus “useless”.
A closer examination of how acupuncture works biophysically (and yes, I do explain this to patients who ask) reveals that it works by simulation of the immune and nervous system. Chris Kresser’s blog elaborates on this quite well. Now is this the only way to stimulate the nervous and immune system? No. Acupuncture evolved from touch/massage. The question thus begged is, why not just touch? My answer is that inserting needles saves time and effort. Imagine if I had to stimulate ten points on a patient with my fingers? By inserting needles to achieve the same stimulation, I can then leave the patient and attend to another one.
So what is my proposal for an appropriate acupuncture “sham” procedure: it must involve NOT triggering the a-delta fibers. A-delta fibers are the key to the “qi-sensation” or heavy feeling accompanying acupuncture (as opposed to sharp). Research has shown that acupuncture analgesia is obliterated by blocking the transmission of a-delta fibers. The best way to do that that i know of is through naloxone. Hypothetically, a control group would have no treatment, another with conventional treatment, and two experimental groups – both with real acupuncture given by the SAME practitioner (more on this later) but with one blocked by naloxone. The latter is the “sham”. ”fake” needles that touch the skin also won’t work because the mere touching of the skin sets off similar reactions in the patient’s central nervous system, albeit to a lesser intensity as with acupuncture.
Now for the importance of the practitioner. I once gave a lecture in a geriatrics convention and a participant commented to me that he used to practice acupuncture but his practice died out. He then asked me “what are the points to use for migraine?” I then said to myself, “kaya pala. (so that’s why…)” What does this incident tell us? Let me illustrate – it also explains to me why it is difficult to formulate studies for acupuncture.
Acupuncture is not just inserting a needle and plugging it into a machine. Acupuncture involves selecting points (although Chris Kresser disagrees with me there) , choosing how thick the needles are, determining how deep the insertion will be, and trying to control the sensations the patient feels through manipulation of the handle. About manipulations, there are many which I shan’t specify now. Suffice it to say that I have personally discovered that errors in any of the above will lead to treatment failure. It is like surgery, the procedure itself is standard, but a lot also depends on how well the surgeon handles things. i would normally not be so heretical as to compare something like acupuncture skills to the taxing physical and mental requirements required of a surgeon, but I hope the reader grasps my point (pun intended.)
Another problem is something I have been trying to get to with my earlier comments on different culture and world view. Chinese medicine diagnoses things in a method somewhat different from western medicine. I’m not just talking about differences in terminology. I did touch on this with the example of dyspepsia. I will try to elaborate more using headache, which is the disease condition that got me into acupuncture in the first place.
Point selection and manipulation in acupuncture depend on too many variables. Ten people can have headaches. One will have it in the front, another at the temples, another at the nape. One will have headache associated with chronic sinusitis, another will have it due to migraines, yet another because he is a computer encoder always looking at CRT screens, another will have it after a flaring temper, yet another associated with menses. Acupuncture treatment then, will seldom be the same for any two of these patients.
Hence, what would be my suggestion for a proper study? In addition to the conditions above, we can also add something to make the patients even more homogenous (can never be totally homogenous though) – same race, same diet, same emotional pattern, same job, same associated factors for the headache. Difficult yes, but necessary because of the nature of proper acupuncture point selection.
Clinical experience has shown that “cookbook” acupuncture, which means taking a western symptom “headache”, or “dysmenorrhea” CAN be effective, but I wouldn’t be surprised if it wouldn’t be AS effective.
What do you guys think?