The Placebo Effect and the Effectiveness of Acupuncture

Recently, a patient sent me an article from the New Yorker by Michael Specter, “The Power of Nothing.” The article is largely about the placebo effect, but it refers to acupuncture in a way I think needs to be addressed. The patient who sent it to me is a longtime client who has benefited considerably from acupuncture and Chinese herbs. I thought this person also deserved a response, and this is what I wrote:

Thank you so much for alerting me to this article and for sending it to me. It’s an interesting article about placebo effect, but it concerns me considerably in the way the article treats Acupuncture and Chinese Medicine. It’s interesting in that Specter, the author, does give a very thorough review of what we know about the placebo effect and why and how people are studying it today. He gives a review of research, quotes researchers themselves, and gives summaries of research articles. The main interviewee, Ted Kaptchuk, an Acupuncturist and Herbalist, says he thinks there’s nothing “wrong” with the placebo effect, it does help people sometimes, and so he wants to understand it better.

I’m basically in agreement with that part. It’s obvious to just about any practitioner that a certain amount of benefit is derived for patients just from the practitioner-patient interaction. However, as one reader who commented on the article a month later points out, it is also known that the placebo effect can only go so far, and for so long. Deeper reaching changes and recoveries need more: “Experienced physicians know that sympathetic concern and reassurance can often allay subjective symptoms—at least temporarily—but only appropriate medical treatment has a chance of curing physical disease.”

The even more disturbing side of this article is that these same people, Specter and Kaptchuk, discount acupuncture in a harmful way, with just a few sentences, and with no proof or clarifications whatsoever! After such a careful elucidation of the placebo effect, why would they do this to acupuncture? At least one statement is not even true.

The article opens by saying that Ted Kaptchuk practiced acupuncture for many years, and then turned to research. There’s an implication that he thought acupuncture didn’t work, and yet later he’s quoted as saying he helped thousands of people. His quoted reasoning is that it wasn’t the needles, but something to do with him personally! This is a pretty big presumption to make without any reasonable evidence presented.

One example is given (the only example) of a patient Kaptchuk said he treated for chronic bronchitis, who then came back saying her ovaries were “cured” as well because of his treatments. Ted says there’s no way the acupuncture and herbs could have done this, but how does he know that? They give no facts, and leave things very vague. How many times did he treat her? Was the woman actually diagnosed with an ovarian disorder, or were they going only to investigate (they say she cancelled her surgery because the pain was gone). Perhaps she just had pain. If just pain, perhaps it was actually related to the chronic coughing, but referred, and clearing the bronchitis cleared that pain as well. If she did have an ovarian cyst, the most likely cause of ovarian pain, cysts are almost always due to what we call “dampness” (think of the fluid inside), and chronic bronchitis is, too (think of the phlegm and inflammation in the lungs). If he cleared this for the lungs, to me it is very likely that it cleared the ovaries as well. We even sometimes use some of the same herbs and points.

Later in the article, Specter states in just one partial sentence that clinical studies don’t demonstrate the effectiveness of acupuncture. Despite the thorough citing of sources elsewhere in the article, here there are no sources or references to research at all. And, in fact, the statement is not even true. A large number of studies have demonstrated the effectiveness of acupuncture, to the point that, ten years ago, the National Institute of Health (NIH) recommended acupuncture for a long list of conditions (PDF). The NIH doesn’t recommend things lightly, and in fact, they said they recommended acupuncture because enough evidence already existed at the time to show its effectiveness. Since then, even more studys have been completed that show the effectiveness of acupuncture.

What is also true is that a number of studies on acupuncture have not been able to show effectiveness, but if these are what Specter is referring to, here again, there is no questioning in his article of why the studies fail; whereas in examining the placebo effect, the article does question the formats of the studies. It has been my experience that many acupuncture studies are not drawn up in a way that can accurately measure the effectiveness of acupuncture and Chinese medicine. In order to fit the current research paradigm, many studies treat everyone with the same disorder with the exact same treatment. This is not how Chinese Medicine works, which is part of its beauty.

It is a statement of fact in Chinese Medicine that each symptom or disorder might be treated by a number of different point prescriptions or herbal prescriptions because every human body is unique. In TCM, we treat based on each individual’s pattern. One person may have menopausal symptoms for one reason, and another person might have a different imbalance that exhibits the same symptoms. Treating them both with the same points and herbs might make one better and the other not, or might even make them worse!Other difficulties in doing research on acupuncture is, in fact, having an effective “placebo” treatment to use as a control. To date, no one has come up with something that feels to all patients like they are getting acupuncture, but which is not acupuncture. No wonder some studies aren’t able to show anything! Add to this that acupuncture is just not a big money maker, so no one wants to put much money into research (a big problem with all research today), and you start to touch on the difficulties.  We need to come up with a new paradigm.

This is something I’ve thought a lot about, having a B.A. in Biochemistry, having worked in research in the biotech industry, and having taught research methodology at TCM schools. (But to go into depth about it is a subject for another article.) Unfortunately, however, I think Michael Specter’s article has some serious flaws that need to be addressed and I’m a bit surprised that Ted Kaptchuk allowed the article to be published; however, not really knowing the man, it’s hard to say. Coincidentally, I happened to just meet someone who is also involved at the Harvard Institute, an insider, who mentioned that several of Kaptchuk’s colleagues were also upset with him about this article. While I understand the need to study the placebo effect, and I also can understand changing from clinical practice after 40 years (it’s hard work) to something that gives more prestige and millions of dollars in grants, I don’t understand why Specter and Kaptchuk felt they had to discredit acupuncture in the process. The nature of the article belies the rigor they say they are trying to promote.

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s