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  Is acupuncture just a placebo?  (June 11th, 2005)

"Acupuncture is just placebo." This is the classic response from skeptics when faced with research that proves that acupuncture is effective for treating many diseases and conditions. What does that really mean?  It seems like a particularly unscientific answer to the question of how acupuncture works.  It strikes me more as a way to conveniently dismiss a system of medicine that has out-lasted most civilizations without any attempt of understanding.

First of all it is important to understand how acupuncture is done: Thin sterile needles are inserted at specific points on the body, and after about 20 - 40 minutes, the needles are removed. No substance is left behind in the body. In many cases the patient gets better, which leaves us wondering how. According to Chinese medical theory, the Qi, or vital energy was balanced and the energetic disharmony within the patient was corrected. To a Western scientist there is often no good explanation to account for the results of acupuncture. Since there is no explanation that easily fits into the biomedical model of life, they reason, it must be placebo.  Placebo becomes something of a magical catch-all category for: "We don't know."  We could simply be honest and say that acupuncture seems to work with many conditions, and we just don't understand how.  But by labeling the effects of acupuncture as placebo the results can be conveniently dismissed without further investigation.  It is a hasty black and white distinction that is drawn on a particularly complex phenomenon (healing) without really considering what it really means.

Both acupuncture and the placebo response elicit healing by stimulating a blocked or dormant healing potential that is built in to being a human being (i.e. not due to exogenous drugs).  In the case of a placebo, it is the patients beliefs or mental states that are blocking this natural ability to heal from within.  In the case of acupuncture it is the blocked or stuck Qi, or energy, that is inhibiting this healing process.  Assuming that they are indeed different, how can we differentiate these two?  

It is well documented that acupuncture works on animals.  Is that enough to suggest that they are different since we tend to believe that animals don't respond to placebo?  Research using highly sophisticated brain scan technology has proven that an acupuncture point on the little toe, classically used to treat the eyes and vision does indeed stimulate the vision centers of the brain.  Is that sufficient evidence to suggest that acupuncture is more than "just" placebo?  

In an attempt to be completely objective, the gold standard for medical research in the United States is the double-blind placebo controlled experiment. Double-blind means that neither the patient, nor the doctor knows if they are receiving a sugar pill or the active drug or therapy. It is a way to control for the beliefs and expectations of both the doctor and the patient to see if a particular drug or therapy is effective on the biochemistry alone without interference of the placebo response.  Theoretically if the group of patients receiving the active drug gets substantially better than the group that only received a sugar pill, it is proof that it was the drug and not the placebo response that was responsible for the results. This method of research is useful with drugs and some therapies, but for therapies such as acupuncture, it is far less so since true placebo acupuncture is very difficult if not impossible to achieve.

Science is not just about doing experiments, it is also about careful observation.  Experimentation is impossible in some fields of science like astronomy.  However with enough careful observations theories can be tested and confirmed.  For those areas of study that are either too complex or too difficult to actually experiment on, science is left with careful observation.  Double-blind placebo controlled experiments do not lend themselves well to even many areas within medicine.  Imagine doctors performing a placebo hip replacement or placebo cosmetic surgery or being prescribed placebo eyeglasses or spending money on a placebo therapeutic massage. The notion is absurd. The only criteria useful to judge the effectiveness of these procedures is whether the patient feels better, can function better and can lead a higher quality of life. Ultimately the results speak for themselves.

The same is true with acupuncture. Since designing experiments that can truly differentiate the effects of the acupuncture from the effects of placebo is extremely difficult, the best way to scientifically evaluate the effectiveness of acupuncture is with case studies, just as they do with other similar medical techniques that don't lend themselves well to the double-blind placebo control standard. Does acupuncture achieve the desired results in a population of people with a particular condition? How it works is a different question entirely and should considered separately from its efficacy.

When skeptics suggest that acupuncture is "just" placebo, they dismiss it because it is assumed that placebo equals "unreal". That acupuncture works cannot be disputed as there are literally thousands of studies worldwide proving its effectiveness from depression and chronic pain to infertility and hundreds of other conditions. Even if acupuncture works by the same biochemical processes as placebo (i.e. eliciting the body to heal itself from within) why is that so important clinically as long as patients get consistent results? Acupuncture can be proven to be effective for many conditions while having fewer risks and side effects than what Western medicine has to offer. To suggest that acupuncture is "just" placebo is really a red herring to the issues of it's effectiveness and it's due place as a medical option. 

Copyright 2005 Oasis Acupuncture

Christopher Vedeler is a Licensed Acupuncturist and Clinical Hypnotherapist in Scottsdale, Arizona, with a Master of Science degree in Oriental Medicine.  He is the owner of Oasis Acupuncture, an Oriental medicine clinic where he operates a general family practice that specializes in treating psychological and emotional disorders including stress, anxiety and depression from the Chinese medicine perspective.  Visit www.oasisacupuncture.com or call Chris at 480-991-3650 for more information.