Acupuncture is alternative medicine

The technical definition of alternative medicine is "any practice that is put forward as having the healing effects of medicine, but is not founded on evidence gathered using the scientific method." The last part suggests that alternative medicine has no medical basis; the reality is that there is a spectrum of alternative medicine practices. Some like chelation do have a scientific rationale (albeit somewhat suspect) and are being put through the rigors of clinical trials to demonstrate any medical benefits. Others like the green coffee bean extract that appeared on the Dr. Oz Show touted as a purported weight-loss supplement are nothing but quackery (and fraud).

One of the most popular forms of alternative medicine is acupuncture. According to Wikipedia, acupuncture is defined as "the stimulation of specific acupuncture points along the skin of the body using thin needles. It is a form of alternative medicine and a key component of traditional Chinese medicine (TCM). According to TCM, stimulating specific acupuncture points corrects imbalances in the flow of qi through channels known as meridians. TCM theory and practice are not based upon scientific knowledge." The idea that the needles when targeted to specific locations in the body can correct imbalances in your qi and thereby confer health benefits certainly falls under the category of alternative medicine. However, this does not preclude the possibility that there is also a scientific basis, and many researchers have explored this possibility.

Acupuncture has been employed to combat a litany of maladies including back pain, headaches and migraines, allergies, depression, cancer, etc. Generally speaking, the most widely-used application is pain relief.

A less common use-case is fertility, but a paper from 2006 caught my attention. On the surface, the data appear to be convincing. The study showed the following:

"Two hundred twenty-five infertile patients undergoing IVF/ICSI (In vitro fertilization/intracytoplasmic sperm injection). In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture.

In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%)."

The experimental design was straightforward: Two groups underwent in vitro fertilization with one group received real acupuncture and the other a placebo acupuncture. The sham acupuncture involves sticking the needles in random locations that are not supposed to influence your qi. This control is necessary to avoid the possibility of a placebo effect caused by having needles poked into your body giving the sense of beneficial treatment even when not done properly (i.e. not inserted in the correct positions). The observed outcome was pregnancy, which is easy to measure.

The real acupuncture group had almost double the pregnancy rate compared to the fake acupuncture group which achieved statistical significance (p < 0.01). However this study by itself is not sufficient; to be truly convincing there has to be more studies perhaps in other institutions with more patients. That has not happened yet. One concern is that that the placebo group somehow did not receive a convincing acupuncture treatment i.e. the practitioners were less enthusiastic with the sham group than the real group.

Despite this encouraging study, most doctors and medical scientists do not believe that acupuncture confers specific health benefits aside from a possible placebo effect. This skeptical position is backed by numerous studies that argue that acupuncture offers no significant pain relief [link]:

"Large multicenter clinical trails conducted in Germany (Linde et al., 2005; Melchart et, 2005; Haake et al, 2007, Witt et al, 2005), and in the United States (Cherkin et al, 2009) consistently revealed that verum (or true) acupuncture and sham acupuncture treatments are no different in decreasing pain levels across multiple chronic pain disorders: migraine, tension headache, low back pain, and osteoarthritis of the knee."

For me a big question mark with respect to acupuncture is the absence of a detailed physiological mechanism. It is thought that acupuncture may somehow trigger the production of endorphins which can produce a calming analgesic (pain-relief) effect. But what cells are making the endorphins? How does the acupuncture needle trigger the production and secretion of endorphins from these cells. Can we measure this endorphin production induced by acupuncture? The mechanistic basis of acupuncture needs to be elucidated if possible.

In summary, according to the current literature, acupuncture must be considered alternative medicine, and any medical benefits from acupuncture are most likely due to the placebo effect. For example, well-administered acupuncture could help the patient relax which would increase fertility even when compared to a sham acupuncture treatment that was perhaps not performed with the same gusto. There are numerous studies that show that stress reduction can aid in fertility treatment. This skeptical view is open to revision pending further research. One fruitful avenue would be animal studies which closely monitor physiological biomarkers during acupuncture (compared to sham acupuncture). Such research could help us understand the mechanistic basis of acupuncture. At the very least, acupuncture could be a powerful technique for unleashing the placebo effect, which would be worth studying in greater depth.

Figure 1. Acupuncture certainly looks relaxing.