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Old 26th June 2009, 06:18 AM   #1
lionking
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Acupuncture - woo or not

I know that this topic has been covered before, but the Australian Government is spending money trialling acupuncture in emergency wards:

http://www.theage.com.au/national/ac...0625-cy8r.html

As far as I can tell, acupuncture relies on tapping into the body's "qi":

Quote:
Two very different theories exist as to how acupuncture works. According to Chinese philosophy, the body contains two opposing forces: yin and yang. When these forces are in balance, the body is healthy. Energy, called "qi" (pronounced "chee"), flows like rivers along pathways, or meridians, throughout the body. This constant flow of energy keeps the yin and yang balanced. However, the flow of energy can sometimes be blocked, like water getting stuck behind a dam. A disruption in the flow of energy can lead to illness.
So what's the latest scientific view? Is this just a scam capitalising on the placebo effect, or is there some real basis for this? Is this taxpayer money well spent?
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Old 26th June 2009, 06:19 AM   #2
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Woo.

Placebo works as well in all cases.
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Old 26th June 2009, 06:33 AM   #3
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Fair enough. If it worked would it qualify for the MDC?
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Old 26th June 2009, 06:51 AM   #4
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If it would, probably not be a MDC applicable if you only told it "works", AFAIK all meta analyze point out to sham acupuncture working as well as acupuncture for certain type of illness. As long as you pick somebody with a point, or needle, it does not matter where, you get a similar result (better than doing *nothing* as control). By the same token homeopathy could be told to work... Not really a good point.

Now what would be probably a MDC challenge if you told it works BECAUSE of the meridian, and the meridian really conduct energy or whatever.
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Old 26th June 2009, 07:01 AM   #5
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Originally Posted by lionking View Post
I know that this topic has been covered before, but the Australian Government is spending money trialling acupuncture in emergency wards:

http://www.theage.com.au/national/ac...0625-cy8r.html

As far as I can tell, acupuncture relies on tapping into the body's "qi":



So what's the latest scientific view?
Even if there were some empirical effect demonstrated for accupuncture, it would ultimately have a physiological basis and would have NOTHING to do with that qi, yin, and yang crap that was in the quote you posted.

This is actually showing up now, and is being discussed over in Orac's blog (Respectful Insolance). There was a recent paper that claimed to show some success for "electroaccupuncture" where the needles have some electrical current through them. After some discussion, a commentor discovered a paper that described previously how electrical stimulation of the given receptors led to this apparent effect. That paper had nothing to do with accupuncture, but was a physiological study.
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Old 26th June 2009, 07:06 AM   #6
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Acupunture is not WOO, it's placebo!

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Old 26th June 2009, 07:22 AM   #7
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Originally Posted by casebro View Post
Acupunture is not WOO, it's placebo!

Fair enough, but is there evidence of this and if so why would a sophisticated, first world medical service be funding it?

Please understand, I am not a supporter of acupuncture.
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Old 26th June 2009, 07:25 AM   #8
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Originally Posted by casebro View Post
Acupunture is not WOO, it's placebo!

If it were just called placebo, of course, it wouldn't be woo. The woo is the fact that it is claimed to act by affecting the qi and yin and yang and "disrupting energy flow".
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Old 26th June 2009, 07:32 AM   #9
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Originally Posted by lionking View Post
Fair enough, but is there evidence of this and if so why would a sophisticated, first world medical service be funding it?

Please understand, I am not a supporter of acupuncture.

It's a very difficult technique to blind securely. And because it is invasive and even uncomfortable, it is capable of evoking a particularly strong placebo response. (The bigger the apparent intervention, the greater the placebo response, very often - it's as if the subconscious were saying, I've gone through all that, it bloody well must do something!)

Thus there is some apparently decent scientific evidence saying that it's doing something. This and the politically-correct attitude that SCAM should be supported and promoted is enough to make healthcare providers look at it seriously.

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Old 26th June 2009, 08:49 AM   #10
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Woocebo?
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Old 26th June 2009, 09:14 AM   #11
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For how to control an acupuncture experiment, I think the only way would be with a general anesthetic.

All the test subjects would be put under, half get acupuncture, half get nothing.

They report how the 'treatment' affected them to a scientitian who has no idea if they got poked or not.
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Old 26th June 2009, 09:22 AM   #12
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Originally Posted by lionking View Post
Fair enough, but is there evidence of this and if so why would a sophisticated, first world medical service be funding it?

Please understand, I am not a supporter of acupuncture.
So it gets more people that believe in woo pay them to be insured by them.
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Old 4th August 2009, 12:44 PM   #13
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OK, I hate to dredge up an old thread, but I searched and this is the only recent one I found with "acupuncture" in the title, and it's relevant enough to what I want to know...I can make a new one, if needed.

Randi's latest article, More Evasion, and the comments to it, prompted me to check out this link: http://www.sciencebasedmedicine.org/?p=492. I shared it with my friends, one of them replied with this: http://apps.who.int/medicinedocs/en/...26e/#Js4926e.5, as if it totally counters all argument against acupuncture.

I'm guessing it doesn't, but I will admit that I'm not a doctor or even any sort of scientician, so I'm having a bit of trouble picking through the whole thing. It does make a case for using acupuncture, and it's published by the World Health Organization - as far as I know, they are a pretty rational group not prone to woo...I thought?

I don't know what to make of it, I guess. And I think that a reply like, "well it's woo because I just know it is, and no evidence to the contrary will convince me" is really kind of missing the point of the whole "skeptic" thing.

Has anyone here seen that WHO link before, or would any kind soul individual care to take a look at it?

In particular, this page has a considerable amount of information that all seems to support acupuncture: http://apps.who.int/medicinedocs/en/d/Js4926e/6.html
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Old 4th August 2009, 02:05 PM   #14
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Originally Posted by rustypouch View Post
For how to control an acupuncture experiment, I think the only way would be with a general anesthetic.

All the test subjects would be put under, half get acupuncture, half get nothing.

They report how the 'treatment' affected them to a scientitian who has no idea if they got poked or not.
That would block the flow of the Qi...or something, perhaps the effect relies somehow on the nervous system. Maybe a drug that blocks memory formation could be used instead.
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Old 4th August 2009, 04:34 PM   #15
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I know several physiotherapists who are convinced it works.

But what exactly does "It works" mean - and is what they use accupuncture?

If spasmed muscle fibres can be triggered to relax by needling, is this accupuncture?
It hardly seems to fit any traditional model.
But are we pedantic to say it is something else?
I get the impression to some people , anything involving the use of accupuncture needles is accupuncture, whether it is targeting accupuncture points or not. Now if I stick enough needles in you, you will feel some effects. Likewise if I smack you with a wok- but is that Chinese medicine, Chinese cooking or just assault with a blunt instrument?
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Old 4th August 2009, 05:36 PM   #16
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I dunno what "accupuncture" is, but you might get more results if you googled "acupuncture"....


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Old 4th August 2009, 05:57 PM   #17
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Well, to answer my own question...I got home and was able to do some quick Googling, and came up with this as a reponse to that WHO study:

A review of the WHO meta-analysis, by the Medical Director of the British Medical Acupuncture Society, and Editor of Acupuncture in Medicine (one would assume he's an acupuncture proponent).
http://www.medicinescomplete.com/jou...0803a02t02.htm
Quote:
It is clear that this report is highly biased in favour of acupuncture; indeed, this commentator had the opportunity to hear a presentation from the author in April 2003. At that presentation, Dr Zhang said that the paper was written: ‘… to show acupuncture works.’ As such, this unsystematic review cannot be used to support the contention that acupuncture is efficacious; however, it may still have some value in terms of hypothesis generation, and in detailing a large number of trials from the Chinese literature. While the latter are likely to be of low methodological quality, they probably represent the best evidence available from a hitherto rather inaccessible portion of the literature.
He doesn't believe the WHO report is reliable, and he's an acupuncturist.

Furthermore, nearly half the data for the WHO report are from China, where studies are unreliable and biased: http://www.pubmedcentral.nih.gov/art...medid=10406751
and
http://www.sciencedirect.com/science...6861a7c970f9c0
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Old 4th August 2009, 09:07 PM   #18
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Originally Posted by Rolfe View Post
I dunno what "accupuncture" is, but you might get more results if you googled "acupuncture"....


Rolfe.
Hey- I make up the spelling, other people make up the results.
It's Chinese, innit?
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Old 5th August 2009, 07:53 AM   #19
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Originally Posted by Rolfe View Post
I dunno what "accupuncture" is, but you might get more results if you googled "acupuncture"....
more acurate results, anyway.
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Old 5th August 2009, 04:39 PM   #20
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Originally Posted by linusrichard View Post
more acurate results, anyway.
sigh
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Old 5th August 2009, 04:49 PM   #21
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He meant " more accurate ressults."
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Old 5th August 2009, 06:14 PM   #22
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Originally Posted by Soapy Sam View Post
He meant " more accurate ressults."
Actually, I'm fairly certain he was being silly, since "accupuncture" was wrong, so he spelled "acurate" wrong also.

That was an appreciative sigh, much like a good pun would warrant one.
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Old 5th August 2009, 11:19 PM   #23
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So there's still no concensus on the effectiveness of acupuncture?
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Old 5th August 2009, 11:21 PM   #24
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Oh no - there's a consensus. Acupuncture is just as effective as a placebo.
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Old 5th August 2009, 11:27 PM   #25
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Originally Posted by rustypouch View Post
They report how the 'treatment' affected them to a scientitian who has no idea if they got poked or not.
A what?
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Old 5th August 2009, 11:49 PM   #26
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Originally Posted by Soapy Sam View Post
I know several physiotherapists who are convinced it works.
It does work. It just works by placebo.

Here's an article that was written about a study on acupuncture that clearly shows that when people received it (or thought they received it), they had better results than the usual care given for back pain. Of course the acupuncture enthusiasts were quick to spin the results of the study to their benefit.
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Old 6th August 2009, 01:47 AM   #27
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Originally Posted by mazyloron View Post
Actually, I'm fairly certain he was being silly, since "accupuncture" was wrong, so he spelled "acurate" wrong also.

That was an appreciative sigh, much like a good pun would warrant one.

Er, as we seem to be torturing fragile jokes to death here, take note of how Soapy Sam spelled "ressults" before assuming he didn't get it....

Rolfe.
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Old 6th August 2009, 01:54 AM   #28
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Originally Posted by MikeSun5 View Post
It does work. It just works by placebo.

Here's an article that was written about a study on acupuncture that clearly shows that when people received it (or thought they received it), they had better results than the usual care given for back pain. Of course the acupuncture enthusiasts were quick to spin the results of the study to their benefit.

No argument there's a placebo effect.
My argument is that physios are possibly achieving an actual, real effect- relaxation of spasmed muscle fibres- by using needles. This is either real or not and I'm not qualified to judge.
Assume for the moment it IS real.

Is it ac(c)upuncture? If muscle trigger points exist and can be affected in this way, it would seem the only connection to the traditional concept is the use of needles. The whole qi / meridian business is removed.
But the people using the needles refer to it as accupuncture. (Dammit, I prefer that spelling and I'm staying with it).

I understand in the USA the technique is also referred to as "dry needling".

If "Trigger Points" don't exist, then this technique is also woo and any result is also a placebo effect, but I don't know whether they do or not.
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Old 6th August 2009, 01:55 AM   #29
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Originally Posted by mazyloron View Post
Actually, I'm fairly certain he was being silly, since "accupuncture" was wrong, so he spelled "acurate" wrong also.

That was an appreciative sigh, much like a good pun would warrant one.
Yep. Hence the "SS" for "Soapy Sam" in "ressults".
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Old 6th August 2009, 02:38 AM   #30
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Originally Posted by Soapy Sam View Post
I understand in the USA the technique is also referred to as "dry needling".

If "Trigger Points" don't exist, then this technique is also woo and any result is also a placebo effect, but I don't know whether they do or not.

I would have to say that from the point of view of my own practice, Trigger Points (TrP's) do exist.

Travell and Simons have written their Trigger Point manual in two volumes and others have written on Trigger Points as well.

The technique is referred to as dry needling in the UK too and yes, lots of physios use this. Personally, I don't.
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Old 6th August 2009, 03:20 AM   #31
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I'm surprised nobody mentioned sham acupuncture. Apparently, it's just as effective as the real one:

http://www.skepdic.com/shamacupuncture.html
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Old 6th August 2009, 05:15 AM   #32
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Is it really only placebo?
If I remember correctly, one hypothesis is that the needle in the skin triggers endorphine release, which could help to reduce pain.
This has nothing to do with the chinese woo, but could be an explanation for the effect, and an explanation why it doesn´t matter where on the body you put the needles in.
Does anybody know anything about that?
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Old 6th August 2009, 06:23 AM   #33
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I don't think anyone has actually demonstrated anything like that is happening. It's a bit like the "it's quantum, man!" explanations for homoeoapthy, only less implausible. A suggested explanation for something that hasn't really been demonstrated to happen.

Rolfe.
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Old 6th August 2009, 06:39 AM   #34
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Originally Posted by SezMe View Post
A what?
Yeah, I have a weird sense of humor. I should come with a disclaimer or something.
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Old 6th August 2009, 06:41 AM   #35
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Originally Posted by Rolfe View Post
Er, as we seem to be torturing fragile jokes to death here, take note of how Soapy Sam spelled "ressults" before assuming he didn't get it....

Rolfe.
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Old 6th August 2009, 07:13 AM   #36
mazyloron
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Back to the subject at hand...

Yes, acupuncture does have an effect. But, it's generally the same as placebo. It's more dramatic in acupuncture than, say, the placebo effect in a study involving taking pills, but the human body/brain tends to match the effect with the stimulus, as Rolfe said here.

This is something that acupuncture (and many other forms of woo) supporters forget, however: if it's not more effective than placebo, then it's not effective. Plain and simple.

Now, the trigger point thing seems to be easily testable, as it's not "the latest in ancient Chinese medicine" or any of that mumbo-jumbo. I'm also not qualified to judge, but at the same time, this seems like a simple concept: if someone inserts a needle into Point A, then Muscle B will relax/contract. Simple, repeatable, testable. If it stands up to testing, then it's a valid technique, and could certainly have plenty of useful applications. It does not, however, validate acupuncture.
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Old 6th August 2009, 07:20 AM   #37
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A few more things I found while checking up on that WHO link I posted earlier, if anyone is interested, or looking for a little more ammo for convincing friends/family who might be a little too credulous:

http://www.bmj.com/cgi/content/full/338/jan27_2/a3115
Quote:
Conclusions: A small analgesic effect of acupuncture was found, which seems to lack clinical relevance and cannot be clearly distinguished from bias. Whether needling at acupuncture points, or at any site, reduces pain independently of the psychological impact of the treatment ritual is unclear.

Also, the Mayo Clinic did a test of acupuncture as a treatment for hot flashes in menopausal women, and found no difference between it and the placebo effect:
http://www.washingtonpost.com/wp-dyn...900833_pf.html

AMA's official statement on "alternative therapies" (which include acupuncture, homeopathy, naturopathy, ayurveda, energy healing, chiropractic, etc.):
http://www.ama-assn.org/ama/no-index...ma/13638.shtml
Quote:
There is little evidence to confirm the safety or efficacy of most alternative therapies. Much of the information currently known about these therapies makes it clear that many have not been shown to be efficacious. Well-designed, stringently controlled research should be done to evaluate the efficacy of alternative therapies.
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Old 6th August 2009, 07:29 AM   #38
ponderingturtle
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Originally Posted by arthwollipot View Post
Oh no - there's a consensus. Acupuncture is just as effective as a placebo.
I thought there was some suggestion that poking needles into people had some more effect than not poking needles into people. It is that it doesn't matter that much where you put the needle.
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Old 6th August 2009, 08:44 AM   #39
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FWIW, The Cochrane Collaboration have some interesting reviews regarding acupuncture. Here are two links with rather positive outcomes.

Quote:
Acupuncture for migraine prophylaxis

From the abstract, authors' conclusions:

In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.
Also this.

Quote:
Acupuncture for tension-type headache

From the abstract, authors' conclusions:

In the previous version of this review, evidence in support of acupuncture for tension-type headache was considered insufficient. Now, with six additional trials, the authors conclude that acupuncture could be a valuable non-pharmacological tool in patients with frequent episodic or chronic tension-type headaches.
Now, I'm not a doctor, so I'm not sure if I read these right, but they state that, at least for these ailments, acupuncture (be it 'real' or sham) is far from useless, right? And Cochrane's fairly highly regarded for it's reviews, right?
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Old 6th August 2009, 10:03 AM   #40
mazyloron
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Originally Posted by ponderingturtle View Post
I thought there was some suggestion that poking needles into people had some more effect than not poking needles into people. It is that it doesn't matter that much where you put the needle.
I think that's where a little communication disconnect happens...some people are considering "placebo" to mean "sugar pill" where others are taking it to mean "sham acupuncture" (sheathed toothpicks tapped on the skin, so the patient doesn't know it didn't pierce the skin), and still others think it means "puncturing the skin with needles in random places, not trying to follow 'Qi meridians'".

When I say it, I mean mostly the latter, or the second one. The effect on people who think their skin has been pierced is similar enough to those who actually were punctured to cast doubt on there being anything more than a placebo effect. Likewise, the effect on people who've had needles stuck in them is relatively similar, regardless of where the needles are stuck, indicating that, again, it's likely a psychological response to the stimulus, and not a direct result of the needle piercing a meridian.

Originally Posted by Tapio View Post
FWIW, The Cochrane Collaboration have some interesting reviews regarding acupuncture. Here are two links with rather positive outcomes.

Also this.

Now, I'm not a doctor, so I'm not sure if I read these right, but they state that, at least for these ailments, acupuncture (be it 'real' or sham) is far from useless, right? And Cochrane's fairly highly regarded for it's reviews, right?
What I think is the telling statement there is this:
Quote:
There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance.
Essentially, the act of poking the patient with a needle is what prompts the response, presumably also because you've told them that they're being poked in order to make them feel better...so, not surprisingly, they do. Which means that it's a placebo effect, just a strong one. It may have a practical application, but saying that acupuncture works just because of this, is misleading.

Alternately, this could be a form of the trigger point theory, which would also have a practical application, yet still in no way prove the Ancient Chinese Medicine theory of Qi and meridians and such.
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