Acupuncture tropes on parade

I sometimes catch flak for repeating this, but there was a time when I thought there might be something to acupuncture. I don’t care, because, as a blogger, when I write a post I assume that a significant fraction of people reading it have never seen this blog before and therefore aren’t even the least bit familiar with what I’ve written before on the subject. That makes them a blank slate, as far as this blog is concerned, and obliges me to explain everything. That time was about nine or ten years ago, and my rationale was, not surprisingly, that, unlike many other alternative medicine interventions, acupuncture involves a physical manipulation that conceivably could do something physiologic. Of course, I never bought the nonsense about how tiny little needles would somehow redirect the flow of qi (life energy) to healing effect. I did, however, figure that maybe there was something to the whole hand wavy bit about releasing endorphins or the adenosine. I wa s wrong. The more I delved into the primary scientific literature about acupuncture, the more I realized that there really is no “there” there, so to speak. Acupuncture is, as David Colqhoun and Steve Novella have put it, a theatrical placebo.

Unfortunately, by and large, in the popular literature the portrayal of acupuncture is largely without skepticism, as though it actually works. Over the weekend, i saw a particularly egregiously credulous treatment of acupuncture online for Washingtonian Magazine by Elissa Miolene entitled Acupuncture: Demystifying an Ancient Practice. I knew it was going to be bad, bad, bad, as soon as I read the subtitle, Why a 2,000-year-old medical practice is being used by Washingtonians today.

After I came across this article, I decided to take a look at it for a couple of reasons. First, it’s chock full of common misconceptions about acupuncture. Second, it’s the very epitome of false balance. No. Strike that. There’s no balance, false or otherwise. The entire article is basically a promotional article for acupuncture, specifically acupuncture services in the Washington, DC area, that is so devoid of skepticism, so devoid of the knowledge of the real history of acupuncture. Miolene starts out with—of course!—an anecdote, hers, in which she undergoes acupuncture and is surprised that it doesn’t hurt as much as she expected. Then, she completely buys into the revisionist history of acupuncture promulgated by acupuncturists and other advocates of acupuncture that presents it as being some sort of ancient discipline that was “discovered” by the West in the 1970s. Really, Miolene should be ashamed and embarrassed at how wrong she gets it:

Acupuncture is an ancient Chinese technique far older than the city of Washington. Some research suggests acupuncture was a common practice as early as 2797 BC. As time went on, acupuncture progressed and was perfected, and the opening of trade routes lead to its spread.

America’s first taste of acupuncture began in the early 1970s. Today, it is officially recognized as both a treatment and a practice, covered on numerous insurance plans including Medicare.

But many still see acupuncture as an out-there practice that has tentative results. However, a 2007 NIH study said that of 5,981 patients suffering from long-term pain, the average success rate after acupuncture treatment was near 80 percent.

This is the study. I can’t help but note that it’s in a journal called Acupuncture in Medicine, which is—shall we say?—not exactly the best journal out there (to put it mildly). I also can’t help but note that this article has nothing to do with long term pain; rather, it’s a systematic review of the literature regarding acupuncture for anxiety and anxiety disorders. You can read it for yourself, but basically it shows nothing, concluding (as is the case with most systematic reviews of acupuncture as an intervention for, well, anything) that “there is currently insufficient evidence from research on acupuncture in the treatment of specific anxiety disorders for firm conclusions to be drawn.”

Same as it ever was. It is, however, rather sloppy not to use the right reference.

I couldn’t resist taking a look at the acupuncture practice where Miolene got her acupuncture treatment and, most likely, much of the information she used in this article. The practice is Transformational Acupuncture, and it’s located in one of my favorite parts of Washington, DC, a part of the city I like to visit whenever I happen to be in DC, namely DuPont Circle. There, a team consisting of acupuncturists and traditional Chinese medicine herbalists peddle their woo to affluent (and almost certainly mostly white, given the location) DC denizens under the leadership of the founder Jeremy Riesenfeld. As is the case with so many who have embraced quackery, Riesenfeld provides a story of “personal healing,” in which he describes his health thusly:

My health was pretty much in shambles – I had bad digestive problems, fairly bad depression, chronic fatigue, and anemia. Luckily, I had signed up for a work-study program at Heartwood Institute, a training center for the holistic healing arts in Northern California, and began my stay there immediately after school.It was there that I was introduced to a wide variety of holistic healing practices – what I now call the 8 Branches of Chinese Medicine. As I received treatment, and practiced meditation, yoga and tai chi, ate a new diet, took herbal medicine, got acupuncture and bodywork, and began addressing my difficult thoughts and emotions, I began to heal.

Actually, I wasn’t entirely correct. Apparently Miolene also got her information from another acupuncture practice, Urban Tao Acupuncture and Herbology, which offers both acupuncture and traditional Chinese medicine.

Now here’s the closest Miolene gets to anything resembling skepticism:

Some critics say a placebo effect is all acupuncture provides. Reisenfeld, not surprisingly, doesn’t see it that way. “If someone’s back pain goes away immediately, and that’s something physical therapy, medication, and yoga didn’t help, why would placebo all of a sudden be able to override past experience because you’re getting acupuncture?” he said.

One can argue that if anything, alternative forms of medicine like acupuncture suffer from the placebo effect instead of benefitting from it. “It’s ingrained that you grow up trusting your doctor more and alternative medicine less.” Boudhili said.

What the heck does that last part even mean? “Suffer” from the placebo effect? That’s all that’s there in acupuncture, placebo effects. It’s all that the therapy has. As for the first part, Reisenfeld is making the same mistake that believers in alternative medicine always make, namely an argument from incredulity. Just because he can’t believe that placebo effects can give the illusion of improvement when other treatments have failed just means that he doesn’t know very much about placebo effects. Sometimes, just trying something new is enough to invoke placebo effects.

I also like how this part is phrased, “Some critics say…” Who are these critics? It’s quite clear from the article that Miolene didn’t bother to interview any critics, as in physicians advocating science-based medicine who can explain how acupuncture is in reality based on prescientific vitalism and how all the science acupuncture apologists use to try to “explain” how it allegedly works comes down to what Harriet Hall likes to refer to as Tooth Fairy science. For those of you not familiar with the term, that’s science studying a phenomenon that hasn’t been shown to actually exist as if it had been proven to exist. As Harriet puts it, we can study the amount of money left by the Tooth Fairy in different settings, but since we haven’t determined that there is really a Tooth Fairy, any conclusions we reach will be falsely attributed to an imaginary being rather than to the real cause (parental behavior). The analogy to acupuncture is obvious.

Finally, one can’t help but note that Miolene falls for the appeal to antiquity, the claim that acupuncture is thousands of years old. While something sort of resembling acupuncture is thousands of years old, what that something was was most likely a form of bloodletting not unlike the bloodletting practiced in the West. Acupuncture in its current form is largely a 20th century invention that was popularized not by Chinese healers but by Chairman Mao, who used it as a substitute for “Western” medicine when he couldn’t provide enough physicians to care for his people. Embarrassingly, in a graphic, Miolene also buys into the “acupuncture anesthesia” story of James Reston in 1971, which was not really acupuncture anesthesia and likely didn’t significantly help Reston. The same graphic touts how the NIH “legitimized” acupuncture in 1997. I’m guessing that it’s referring to the 1997 NIH Consensus Development Conference Statement that is highly flawed because most of the research referenced occurred before the time when effective sham placebo procedures had been developed to use in randomized clinical trials as placebo.

Perhaps the most highly misleading part of this graphic is the part that proclaims “President Obama recognizes acupuncture as a profession” in 2014. Personally, I must have missed that one, because I never heard about it in 2014, and, given what this blog is about, I highly doubt I could have missed stories about something that, had it happened, would have been monumental in the world of “integrative medicine.” So I did some Googling. Apparently what Miolene is referring to is a petition asking the government to recognize acupuncturists as health care providers under Medicare. The response by the Obama administration was hardly what I would characterize as “recognizing acupuncture as a profession.” I mean, seriously, did Miolene even read the danged thing? Basically, it said that acupuncturists are not recognized as health professionals under Medicare because the statute doesn’t include them and that to recognize them as such would require passing a change in the relevant statute by Congress, even going so far as to say:

As prescribed by law, CMS develops NCDs [National Coverage Determination]. These national policies, which are made through an evidenced based process with opportunity for public participation, serve as generally applicable rules to ensure that similar claims for items and services are covered in the same manner. NCDs may grant, limit, or exclude Medicare coverage for particular items and services, and there are three NCDs on acupuncture. After careful study of the available evidence, it was concluded that acupuncture is not reasonable and necessary under section 1862(a)(1) of the Social Security Act. Therefore national noncoverage for acupuncture continues.

And, no, Medicare does not cover acupuncture, contrary to what Miolene explicitly writes in her article.

Some might wonder why I did a one of my typical posts about an article in a publication like Washingtonian about how great acupuncture is and why it’s so popular in our nation’s capital, as evidenced by the proliferation of acupuncture practices all over DuPont Circle and beyond. The reason is simple. Rarely have I seen such a nice (if you can call it that) distillation of very common tropes and misinformation about acupuncture used by acupuncturists to promote their quackery that are frequently repeated in news stories and almost just as frequently go completely unchallenged. That’s all it takes. That, and nothing else catching my attention last night.