Back when I started this blog, I hadn’t yet become aware of the phenomenon known as quackademic medicine. This phenomenon, as you recall, is the infiltration of academic medical institutions that should be bastions of science- and evidence-based medicine by outright quackery. In quackademic medicine, we see Very Respectable Academic Physicians and Scientists wasting their time studying faith healing like healing touch and reiki, prescientific medicine based on primitive vitalism such as traditional Chinese medicine and (of course) acupuncture, and even sympathetic magic like homeopathy. It’s gotten to the point where there are actually doctors who claim that scientific medicine is “truly nonsense,” to which Orac responds, “Bullshit!”
Similarly, there are doctors who believe acupuncture is something other than prescientific superstition based on vitalism. They actually think there’s something to it. I can understand; there was a time when I thought there might be something more than placebo to acupuncture. After all, unlike so much other alternative medicine, acupuncture involves physically sticking needles into the skin. It’s conceivable that such minor trauma can trigger something or cause a neurological signal. Certainly I never believed that rot about qi (life energy) and how thin needles stuck into certain points in the body just so will somehow redirect or unblock that qi to healing effect. Of course, as my oeuvre here on this blog demonstrates, over time as I read the acupuncture scientific literature more and more it became very clear to me that acupuncture really is nothing more than theatrical placebo. It doesn’t work.
Unfortunately, in the world of quackademia, of all the alternative medicine quackery (but I repeat myself) that is increasingly being “integrated” into integrative medicine, acupuncture appears to be among the most popular, the one taken the most seriously. That doesn’t stop quackademics from doing more and more outlandish studies of acupuncture or its various bastard offspring. Worse, not content to stick needles into humans, acupuncture quackademics subject various animals, particularly rats and mice, to having needles stuck into them for no good reason. Worse, because of the way these experiments are generally done, they kill a lot of animals for no real gain in scientific knowledge.
A biological mechanism explaining part of the mystery of acupuncture has been pinpointed by scientists studying rats.
Stimulation with electroacupuncture – a form of the therapy in which a small electric current is passed between a pair of needles – blunted activity in a key hormonal pathway linked to stress, chronic pain and mood, the researchers found.
The findings provide the strongest evidence yet that the ancient Chinese therapy has more than a placebo effect when used to treat chronic stress, it is claimed.
Rats had needles inserted at an especially powerful acupuncture point known as stomach meridian point 36 (St36). Although linked to digestive problems and multiple other ailments, St36 is on the shin.
Traditionally, acupuncture involves unblocking energy paths known as meridians that flow around the body, keeping it in balance.
Won’t someone think of the poor lab rats?
Usually, these stories are based on breathless press releases:
In animal models, acupuncture appears to impact the same biologic pathways ramped up by pain and stress, analogous to what drugs do in humans. Georgetown University Medical Center (GUMC) researchers say their animal study, published online in Endocrinology, provides the strongest evidence to date on the mechanism of this ancient Chinese therapy in chronic stress.
“The benefits of acupuncture are well known by those who use it, but such proof is anecdotal. This research, the culmination of a number of studies, demonstrates how acupuncture might work in the human body to reduce stress and pain, and, potentially, depression,” says the study’s senor investigator, Ladan Eshkevari, PhD, CRNA, LAc, associate professor in the department of nursing and the department of pharmacology and physiology at GUMC.
“We have now found a potential mechanism, and at this point in our research, we need to test human participants in a blinded, placebo controlled clinical study — the same technique we used to study the behavioral effects of acupuncture in rats,” says Eshkevari, a nurse anesthetist and licensed acupuncturist. She is assistant program director of the Nurse Anesthesia Program at Georgetown’s School of Nursing & Health Studies.
Won’t someone think of the poor humans now? Not at that bastion of quackademia, Georgetown, where this study was done.
In any case, these stories follow a template. Basically, every study is represented as “the strongest evidence yet” that the “ancient Chinese therapy” (which, remember, really isn’t particularly ancient, at least not the way it’s practiced) is more than placebo and that a definitive mechanism has been found for this magic to work. In this particular case, notice how it’s claimed that acupuncture does the same thing as actual drugs used to treat stress and pain. So it must be real! In every case, if you go and look at the actual study, there’s way less there then is being sold. This case is no different, as I saw when I looked up the actual study, Effects of Acupuncture, RU-486 on the Hypothalamic-Pituitary-Adrenal Axis in Chronically Stressed Adult Male Rats.
The first thing I noticed about this study is a common bait-and-switch used by acupuncturists, in which they do something called “electroacupuncture” (EA), in which acupuncture needles are hooked up to an electrical source and a week electrical current applied. Whenever I see this bait-and-switch, the first question that comes to mind is: Those ancient Chinese must have been really brilliant to have discovered how to use electricity thousands of years ago. Obviously, attaching electrodes to acupuncture needles is a more modern twist on acupuncture, which is why the language about this “ancient Chinese therapy” is so grating. This is not ancient at all, nor is it acupuncture. Really, it’s just transcutaneous electrical nerve stimulation (TENS) grafted onto acupuncture to produce a mutant Frankenstein monster of a therapy that has little to do with either. When I see a study like this, my usual reaction is a big, “So what?” This doesn’t demonstrate that acupuncture works. If it demonstrates anything at all (which is questionable) it demonstrates that passing an electrical current through the skin has physiological effects.
Does the study demonstrate anything? Let’s take a look. There were two experiments. In the first, the investigators divided the the rats into four groups. Three of these groups were stressed and were divided into groups receiving electroacupuncture; sham acupuncture (delivered to an area that is not an acupuncture point); and a third group that did not receive acupuncture. A fourth group of animals served as controls; they received no acupuncture and were not subjected to the stress stimulus. Two experiments were done. In the first, the animals received were placed in 1 cm deep icewater for one hour daily for 14 days, after which they were returned to their cages. On day 5 experimental treatments were begun, which consisted of acupuncture or sham acupuncture 30 minutes after the cold exposure. (Poor rats.) The acupuncture point used was St36, which in humans is on the leg, one finger width lateral from the anterior boarder of the tibia and four finger breadths below the patella. Its action and effects are said to include:
- Tonify deficient Qi a/or Blood.
- Tonify Wei Qi and Qi overall – low immunity, chronic illness, poor digestion, general weakness, particularly with moxibustion, very important acupuncture point for building and maintaining overall health.
- All issues involving the Stomach a/or the Spleen – abdominal/epigastric pain, borborygmus, bloating, nausea, vomiting, GERD, hiccups, diarrhea, constipation, etc.
- Clear disorders along the course of the channel – breast problems, lower leg pain.
- Earth as the mother of Metal – will support Lung function in cases of asthma, wheezing, dyspnea.
- Psychological/Emotional disorders – PMS, depression, nervousness, insomnia.
The nonacupuncture point used as “sham” for sham electroacupunture (sham-EA) was on the back 2 cm lateral to the tail region. The needles were then attached to an electroacupuncture machine via electrodes and were stimulated for 20 minutes at a frequency of 10 Hz with 2 mA output. Ten of the 14 rats in both the sham-EA and the EA St36 groups continued to receive EA for the 14 days that they were exposed to the cold stress. However, after 10 days, 4 of the animals in each of the sham-EA and EA St36 groups stopped receiving the EA treatments, whereas exposure to cold stress was continued for the remaining 4 days, to determine whether the effects of the sham-EA and/or EA St36 were long lasting.
In a second experiment, rats were assigned to five groups: Group 1 (no treatment and no RU-486); group 2 (no treatment but started RU-486 at day 10); group 3 (daily cold stress and start RU-486 at day 10); group 4 (sham EA + RU-486 + cold stress); and group 5 (EA + RU-486 + cold stress). The mice were also tested in other stress tests, including the forced swim tests and open field test. In this case, RU-486 was not used for its properties that allow it to work as a “morning after” pill, but rather for its ability to block the glucocorticoid receptor, the hypothesis being that however EA “works” it does so through glucocorticoid (steroids).
The first thing I noticed was that levels of ACTH (which stimulates cortisol production) and cortisol were not impressively different, particularly ACTH. Indeed, the differences in ACTH are so modest that my reaction was a yawn. Cortisol showed more difference, but a most unimpressive difference between EA and sham-EA. In the second experiment, there were a whole lot of graphs that didn’t show much difference in anything. The best that the authors could say is that RU-486 didn’t affect EA or sham-EA, but that ACTH didn’t go up in the St36 group. It was reported that stress behaviors were less in stressed EA St36 animals, but looking at the graphs sure didn’t impress me. Basically, the authors conclude that application of EA St36 after initiation of chronic stress prevents the stress-induced increases in the hormones evaluated, adding that “this action may be specific to EA St36 vs the sham points used, as sham-EA does not prevent the rise in stress hormones as effectively.” One notes that sham did have an effect. The effect, if real, was very modest.
The kindest description of the conclusions of this study is that it shows that running electrical current through the leg, as opposed to running current through the skin of the back, might decrease stress by decreasing the effect of stress hormones. It does not show that acupuncture works. A more realistic description of these results is that they don’t show much of anything interesting. One even wonders if, for instance, there is a simpler explanation, namely that having a needle stuck in the leg and having current run through it hurts less than having a needle stuck in the back and having current run through it. There’s no way of knowing because we can’t ask the rat.
What I can ask is why money is being wasted on silly experiments like this. The study was supported by an American Association of Nurse Anesthetists doctoral fellowship award. One would think that the AANA would have better things to spend its money on than this nonsensical “science.”