Definite Proof: Acupuncture More Than Placebo
Enough with answering back at mudslingers. I get more than enough of that in the local media, with the Philippine elections just around the corner. Let’s move on to being proactive instead of being defensive.
A common “debunking” technique of anti-acupuncture bigots is to come up with “evidence” that acupuncture is clinical similar to placebo and then “conclude” that acupuncture is therefore useless or irrelevant. This plays the assumption that placebo = no effect, when in actuality placebo = the doc does nothing but the patient feels an effect. (http://qi-spot.com/2010/04/28/the-smear-campaign-continues-acupuncture-does-not-relieve-childbirth-pain/)
Of course, even if both acupuncture and sham acupuncture have clinical effects that seem similar (and studies have shown that the real thing beats the fake stuff, even if not by much), the argument the skeptics pose is that if acupuncture is no different than placebo, then what’s the point of doing real acupuncture at all?
Well, a while back, I posted about a study I was looking forward to. (http://qi-spot.com/2010/04/04/a-study-to-look-forward-to-acupuncture-more-than-just-placebo/). Thanks to Chris, I now have the whole article. I would like to start by quoting thus:
As long as acupuncture and sham acupuncture treatments produce similar clinical improvements, the results of respective trials can only be taken as evidence against the efficacy of acupuncture. (I don’t think so… – Philip) Only when it can be shown that acupuncture and sham acupuncture effects are mediated differently, this can be taken as evidence that acupuncture effects are different from placebo effects, although both may still be equally effective.
I still can’t help but detect a bit of bias. When something can be interpreted negatively, it “can only be taken as evidence against…” meaning there is no other way to interpret it, supposedly.
Still the point is valid. If we can show that the real deal triggers physiologic reactions distinct from sham, then that should construe evidence that acupuncture is not only valid, but should be encouraged.
According to the article “Acupuncture, Psyche and the Placebo Response” (the article mentioned above) they HAVE found such physiologic differences. Why does this matter? It matters because a) skeptics can’t say it’s like placebo anymore and b) we now have an increased knowledge of acupuncture mechanism of action, which is more than what we can say for such western drugs as lithium.
So how does the real thing differ from the fake stuff? Let’s count the ways as enumerated by Enck et al:
a) “Acupuncture but not sham acupuncture was found to induce both cerebellar as well as limbic cortex activation indicating both motor as well as affective component modulation of the pain matrix. Acupuncture resp. electroacupuncture at non-acupuncture points and tactile stimulation alone served as controls in early fMRI studies (Wu et al., 2002; Yoo et al.m 2004)
b) Verum (true) acupuncture in contrast to non-penetrating placebo nedles activated cortical centers involved in affective pain modulation (Chae et al., 2009)
c) Greater activation of sensorimotor areas by sham procedure (superficial manipulation at acupuncture points) than by true acupuncture (Napadow et al 2009) – (note that stimulation of true acupuncture points by non-needling methods was considered sham by the authors, whereas in chinese medicine it is a valid method of stimulation)
d) Variances of time of central activation between verum and sham acupuncture, attributed to stronger peripheral actions of true acupuncture
e) PET scans on fibromyalgia patients show that needling at true points elicited significant activation of mu opoid receptor binding capacity in the cingulate, caudate, thalamus and amygdala both after one session and after four weeks, while with sham (insertion into non acupuncture points), small DEactivations were noted, an effect that is seen with placebo analgesia. (Zubieta et al., 2005)
There are more, but these should suffice to prove the point.
All in all I believe this evidence validates my personal belief that real acupuncture has longer lasting effects than sham acupuncture. This is shown by the fact that real acupuncture has more central (meaning up in the brain, as opposed to just local pain mediation) effects.
Another thing worth noting is that different people have different definitions of sham. For some, it’s using real points but not inserting. For others, it’s inserting into non-acupoints. Logic dictates that both have different effects. Controls used in acupuncture studies should be standardized!
The crazy thing is that all this has been known by Stux, Berman and others since I was in grammar school in the early 80s! Jeez!
Enck, P., et al., Acupuncture, psyche and the placebo response. Auton. Neurosci. (2010), http://www.ncbi.nlm.nih.gov/pubmed/20359961
Harris, Zubieta et al. ” Traditional Chinese Acupuncture and placebo (sham) acupuncture are differentiated by their effects on Mu-Opioid Receptors (MORS)” Neuroimage. 2009 Sep; 47(3):1077-85. Epub 2009 Jun 6. http://www.ncbi.nlm.nih.gov/pubmed/19501658