More Tooth Fairy science studying acupuncture

I must confess, I had a rather rough time yesterday. Actually, it’s been a rough winter, at least as far as my car is concerned. Record amounts of snow and a January much colder than usual have wreaked havoc on the roads around where I live, producing craters that make our roads and freeways look more like the surface of the moon than anything you’d want to go speeding along on in an automobile. So it was that about a month ago on my way to work I couldn’t avoid a particularly nasty crater, and immediately after I hit it I knew something was wrong. My tire pressure light went on, and the car started handling sluggishly. Yes, sure enough, I had the first flat tire I had had in a very long time—many years. The damage was too bad, and I had to replace the tire, although, fortunately, the rim was fine. Even more fun, it was one of the coldest days of the year (up to that point). So what should happen last night on my way home from work? Yep, you guessed it! I hit another pothole and blew out another tire. Worse, it was along a stretch of freeway that, trust me, you don’t want to get off of to go into the surrounding neighborhoods. Those of you who know which metro area I live in know just how bad those neighborhoods can be. Eventually I got some help and managed to get home but that was a—shall we say?—less than pleasant experience.

So as I write this I’m tired. Yet, at the same time, I’m a bit amused. I’ve made fun of what happens when a quack gets a hold of a microscope and uses it to look at everyday food (like chicken nuggets), expressing amazement that things look really strange when magnified. It was so hilariously precious. Then a real doctor made epic pronouncements based on looking at a single chicken nugget under the microscope and expressing amazement that there is vascular and nerve tissue in there. This study is a bit different in that, for once, it’s not food being looked at under the microscope. Also, here we’re talking scanning electron microscope images, not regular old light microscopy. What makes this study silly is not so much that the scientists doing it misinterpret or overinterpret what they see. Rather, it’s that they bothered at all to do such an utterly pointless experiment. You’ll see what I mean in a minute.

I became aware of this study when a news story popped up on my news feed, Research examines acupuncture needle quality, which spinned the story thusly:

The quality of needles used in acupuncture worldwide is high but needs to be universally improved to increase safety and avoid potential problems such as pain and allergic reactions, RMIT University researchers have found.
The researchers looked at surface conditions and other physical properties of the two most commonly used stainless steel acupuncture needle brands.

The study, published in Acupuncture in Medicine today (13 February), found that although manufacturing processes have improved, surface irregularities and bent needle tips have not been entirely eliminated.

From the article and the study, which is open access, meaning that you, too, can be amused the way that I was, you’d almost think that we were dealing with an actual medical device that’s worthwhile. In fact, this study is perhaps the most blatant example of what Harriet Hall refers to as “Tooth Fairy science” I’ve seen in a very long time. She dubbed such science “Tooth Fairy science” because you can study the amount of money left by the Tooth Fairy in different settings, but since it’s never been established that the Tooth Fairy actually exists, any conclusions will be, as Hall puts it, “falsely attributed to an imaginary being than to the real cause.” The analogy to acupuncture is obvious, because with acupuncture, we are studying an elaborate, ritualistic placebo effect, rather than any sort of “life energy” or “qi” being used to healing effect. This study is taking Tooth Fairy science to a new level by subjecting acupuncture needles to various tests, the assumption being that it matters to the therapeutic effect that the acupuncture needles have certain characteristics. When it doesn’t matter whether the acupuncture needles are inserted into the “real” acupuncture points or sham acupuncture points and twirling toothpicks against the skin does as well as real acupuncture needles, that is an assumption that is unwarranted. Yet, here we are.

It’s clear from the very beginning that the investigators are True Believers. You can tell just from the way the introduction is written:

Acupuncture is a therapeutic modality that involves inserting needles into certain points of the human body. It has been used in clinical practice for thousands of years and is currently being practiced globally.1 ,2 In modern China, traditional Chinese medicine including acupuncture accounts for 40% of medical treatment,3 while in Western countries acupuncture is one of the most frequently used complementary/alternative therapies.4–8

The use of acupuncture can perhaps be traced as far back as the Stone Age (around 3 million years ago) in ancient China, using the Bian Shi (sharpened stones) to stimulate certain points on a patient’s body to achieve therapeutic effects. The use of Bian Shi was followed by fine needles made of other materials such as bamboo, ceramic, bones, the thorns of plants, the beaks of birds and metals (including gold, silver, bronze and, more, recently stainless steel).1 ,2 ,9 Modern-style acupuncture related therapies can be applied via a range of equipment including needles, acupressure pellets and electrical or laser stimulation. However, among all these forms of treatment needling acupuncture involving skin penetration is the most frequently used method, in China and in other countries. It is estimated that 1.4 billion acupuncture needles are used each year worldwide.10

Wow! Not content to parrot the usual line about acupuncture being 2,000 or more years old, these guys push it back far, far into prehistoric times. Heck, they push it back to times before modern humans had even evolved from their hominid ancestors! After all, Homo sapiens first appeared only around 200,000 years ago, and even Homo erectus only appeared approximately 1.8 million years ago. Three million years ago, the hominid ancestor of modern day human beings that predominated was Australopithecus africanus, which lived in Africa between 3.3 and 2.1 million years ago. While it’s true that Australopithecus made and used simple stone tools, I had no idea that these hominids could use sharpened stones to heal themselves, although if they did it would mean that acupuncture actually developed in Africa, not China. Even worse, let’s just, for the sake of argument, accept that Australopithecus did acupuncture using sharpened stones. If that’s the case, how on earth would paleontologists know that that’s what these hominids used putative stone acupuncture implements for? It’s not as though there was writing, or anything, and it’s not as though such implements would be likely to look a lot different from stone blades and other common tools. The whole assertion is just so incredibly stupid, and, based on that one assertion alone (that acupuncture dates back 3 million years), the people who oversee all the BMJ journals should hang their heads in shame for allowing this acupuncture journal into their stable of journalse. Burning stupid doesn’t even begin to describe it. Thermonuclear stupid starts to get at least in the same solar system. Maybe solar stupid, as in burning stupid as hot as the heart of the sun, would be a decent description of the ignorance embodied in that one sentence.

As has been explained right here on this very blog and elsewhere, no, acupuncture as it is commonly practiced now, is not even thousands of years old. Rather, acupuncture, the way it is practiced now with very thin needles, is probably less than 100 years old, and, in fact, was popularized by Chairman Mao, along with the rest of “traditional Chinese medicine.” In reality, acupuncture probably evolved from bloodletting treatments not unlike bloodletting used by medieval healers in Europe that utilized much larger “needles” as cutting implements. This story of the history of acupuncture reads like the history of the Tooth Fairy that leaves out one rather essential element, namely that the money that seemingly magically appears under children’s pillows at night when teeth are left there is put there by the children’s parents, not some magical Tooth Fairy. Similarly, this history neglects to mention that acupuncture was based on magical thinking, that there is no such thing as “qi,” and that sticking needles in the skin doesn’t “redirect the flow of qi.”

Forging bravely ahead into the depths of pseudoscience, the authors decided to examine the quality of single use acupuncture needles purchased from several different companies. To do this, they examined a random sample of ten needles different brands of disposable acupuncture needles. They even doubled down on the Tooth Fairy science by taking images of these needles after they had undergone a standard manipulation with an acupuncture needling practice gel, at which time they did a comparison of forces and torques during the needling process.

So what did they find? Really, it almost doesn’t matter what they found, because this is Tooth Fairy science. Basically they used materials science to study the quality of tools used to practice magic. You can look at the images for yourself to see what they found, but basically the scanning electron microscope (SEM) images revealed what the authors characterized as “significant surface irregularities and inconsistencies” at the needle tips, particular from one brand of needles. They noted “metallic lumps” and “small, loosely attached pieces of material” on the surfaces of some of the needles and that some of the lumps disappeared after acupuncture manipulation, meaning that these small pieces of metal could have lodged in patients, leading the authors to conclude:

If these needles had been used on patients, the metallic lumps and small pieces of material could have been deposited in human tissues, which could have caused adverse events such as dermatitis. Malformed needle tips might also cause other adverse effects including bleeding, haematoma/bruising, or strong pain during needling. An off-centre needle tip could result in the needle altering its direction during insertion and consequently failing to reach the intended acupuncture point or damaging adjacent tissues.

Improving the quality of acupuncture needles and thereby reducing the likelihood of complications are both good things, of course, but what is unspoken (but should be spoken) is that there is no legitimate medical reason to be sticking these needles into people anyway because acupuncture doesn’t work. Reducing the risk by encouraging better manufactured needles doesn’t change the risk benefit-ratio. The risk-benefit ratio is still infinite, because the benefit in the denominator is still zero. Or, if you prefer to look at it another way, the benefit to risk ratio is still zero because the benefit is zero. The answer is to stop doing acupuncture, not to subject acupuncture needles to SEM.

None of this stops our intrepid band of Tooth Fairy researchers from speculating:

The commonly seen bleeding or haematoma/bruising was possibly caused by unsmooth needle tips breaking small blood vessels during needle insertion. Highly malformed tips were found in several H needles. This could be the reason for the occasional unexplained strong pain in the needling area reported by some patients during acupuncture.9 An off-centre (eg, H10) or an unsymmetrical (eg, H3) needle tip may also cause the needle to alter direction during insertion.9 If the flaws at the needle tip are eliminated through adequate quality control of the needle manufacturing process, such acupuncture needling associated adverse effects may well be reduced.

All of this might be true, but it completely misses the point, again, namely that acupuncture doesn’t work; so placing needles into the skin, no matter how low the risk of complications is, is not medically justifiable, at least not if your goal is healing. I realize that people place needles into the skin all the time for various non-therapeutic purposes like tattoos and piercings, but no one claims that tattoos and piercings are medicine. Acupuncturists do claim that their violation of the skin with metal needles is medicine. So the brain trust at RMIT University in Melbourne did an SEM study.

Tooth Fairy science marches on and on.