Acupuncture: how its supporters move the goalposts

I’ve always been suspicious of acupuncture. I had it once, and although the needles didn’t bother me the garbage being talked by the woman sticking them in certainly did.* Maybe it’s slightly more credible than homeopathy but then so is reading tea-leaves.

Anyway, let me draw your attention to this blog post by Dr Edzard Ernst, who was disgracefully hounded out of his post as Professor of Complementary Medicine at Exeter University for doing his job – i.e., assessing the credibility of claims for alternative medicine and finding most of them deeply flawed.

Ernst tears to pieces a paper in BMC Complementary and Alternative Medicine, the official journal of the International Society for Complementary Medicine Research (ISCMR).

The paper suggests that something called ‘real-world research’ (RWR) is better at measuring the efficacy of acupuncture than randomised controlled trials (RCTs). And here are the principles of RWR:

1. Acupuncture should be regarded as complex and individualised treatment;

2. The study aim (whether to assess the efficacy of acupuncture needling or the effectiveness of acupuncture treatment) should be clearly defined and differentiated;

3. Pattern identification should be clearly specified, and non-needling components should also be considered;

4. The treatment protocol should have some degree of flexibility to allow for individualisation;

5. The placebo or sham acupuncture should be appropriate: knowing ‘what to avoid’ and ‘what to mimic’ in placebos/shams;

6. In addition to ‘hard evidence’, one should consider patient-reported outcomes, economic evaluations, patient preferences and the effect of expectancy;

7. The use of qualitative research (e.g., interview) to explore some missing areas (e.g., experience of practitioners and patient-practitioner relationship) in acupuncture research.

Uh-huh. Sounds reasonable? Not to Ernst. He writes that it immediately set off his ‘BS detector’. The authors insists that acupuncture is ‘complex intervention’ – meaning what? So are all drug treatments. He asks:

Does that mean that drugs and all other interventions are exempt from being tested in rigorous RCTs? Should we allow drug companies to adopt the RWR too? Any old placebo would pass that test and could be made to look effective using RWR.

So why are the authors of this paper – all from Chinese medical institutions – so desperate to introduce a new methodology? I’m sure one answer has occurred to you, and Ernst spells it out:

I fear, the reason is that RCTs might show that it is not as effective as its proponents had hoped. The conclusion about the RWR is thus embarrassingly simple: proponents of alternative medicine want double standards because single standards would risk to disclose the truth.

In plain English, this is called moving the goalposts. Supporters of alternative medicine do it all the time.

* Oh, and it didn’t work.




  • Jadissock

    Watching “Child Genius” the other night, I saw one of the “genius” mothers engaged in “cupping” her unfortunate prodigy. “What’s that?” said a junior historian of the Royal Household.

    Just something the Europeans used to do in the 16th Century when they still believed in Galen’s “four humours”. I replied.

    Cue disbelief. “No, you are just being racist”.

    Bye-bye Rhino, and Tiger – culled to make Chinese Viagra. Would love to save you except that would be racist.

  • justlookin

    Acupuncture works – billions of Chinese over several millennia can’t be wrong.

  • Fiona1933

    I was also very skeptical of all complementary medicine until I experienced it myself. You cannot use randomised controlled trials. This is not like testing a drug. Shiatsu, for example: it works, it absolutely works. But first, it is a gradual process. And most of all, it is an individualised process. Your experiences are entirely your own and the way they are stored in your body is your own. In my case, I had spinal damage from carrying a heavy bag as I was growing. It pulled the whole left side of my body down, weakening the muscles on the other side and so the disc slipped..I spent weeks in terrible pain. After this, the whole lower back froze up. Even as I strengthened the muscles, the back would not release and was held in a an arch. The doctor just shrugged and said “live with it”. Shiatsu, though…how can I describe it? One night, after treatment, suddenly, sitting on the couch., a memory flashed up…all the way from primary school..a painful memory…I hadnt thought of it in 40 years! But not only the memory, but the feelings too were present, and I found tears were streaming down. but at the same time I ‘heard” or ‘sensed’ a ‘voice’ telling me that I did not need this anymore. And I felt a powerful physical release. I came to see that stress and bad memories and fear are all ‘held’ in your body as well as your memory and the treatment can get rid of them. Extraordinary experiences: once I truly thought the place was on fire, I smelled burning so strongly, often I will smell sawdust, or a smell of garbage…how this is being induced by a person who is scarcely touching you, I dont know. After six months I began every night to wake up with my whole spine writhing up and down like a big snake and a sense of burning heat. Anyway, after 2 years, my back issues were 70% better. My arched back can lie flat. I am not lop-sided…even my face is more symmetrical. I could go on for hours. But here’s the thing: how could any of this be duplicated? How can you do a control? I worked hard with the therapist and she has often said I am her best client regarding concentration…this makes the treatment more intense. The longer you go on with it, the more able you are to relax and forget the outside world…more intense again. but that is just me! anyway, it takes years to achieve serious results. Doctor, btw dismissed it all as imagination, ignoring anything I had to say regarding the loosening of the back, the deep relaxation in the stomach (startling stuff..singing bowl treatment), the side benefits such as control of temper and impatience and anxiety which were all connected with the damaged nerves.
    This stuff is powerful. And I came to it not knowing what it was, thought it was just massage, and with no intent to believe.