Acupuncture–Still a Placebo After All These Years |

The scientific evidence supporting the effectiveness of acupuncture is far weaker than is widely supposed, even among those committed to science and science-based medicine. It has been repeatedly shown that the measurable physiological effects and apparent clinical benefits of sticking needles into people or animals are non-specific and do not depend on putting those needles in any particular place or even actually penetrating the skin (since fake needles and even jabbing the skin in random places with toothpicks work just as well as “real” acupuncture). Over and over again, research has shown that even with the inability to truly blind therapists to whether or not they acupuncture they are giving is real or fake (which is an important potential source of bias), acupuncture works no better than placebo, even for the symptom most often cited as one acupuncture is proven to treat, pain.

Sadly, facts are relatively impotent in the face of belief, and the accumulation of evidence against any real physical benefits from acupuncture doesn’t seem to have much impact on the popularity of the practice, which is still quite low but higher than one might expect for a placebo treatment. Nevertheless, I maintain a perverse belief that the truth matters and that facts have meaning, so I guess I will keep looking for and sharing them. Another study has recently been published which demonstrates yet again that 1) sham acupuncture is just as effective as “real” acupuncture, 2) patients’ beliefs about acupuncture strongly affects whether it seems to them to help, and 3) the individual doctor, and presumably their manner or how they present the therapy, has more of an effect on whether the patient feels better than whether or not the patient actually had acupuncture or a placebo treatment.

White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G.Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture. Pain. 2011 Dec 12. [Epub ahead of print]

The nonspecific effects of acupuncture are well documented; we wished to quantify these factors in osteoarthritic (OA) pain, examining needling, the consultation, and the practitioner. In a prospective randomised, single-blind, placebo-controlled, multifactorial, mixed-methods trial, 221 patients with OA awaiting joint replacement surgery were recruited. Interventions were acupuncture, Streitberger placebo acupuncture, and mock electrical stimulation, each with empathic or nonempathic consultations…

Improvements occurred from baseline for all interventions with no significant differences between real and placebo acupuncture…or mock stimulation… Empathic consultations did not affect pain…but practitioner 3 achieved greater analgesia than practitioner 2… Qualitative analysis indicated that patients’ beliefs about treatment veracity and confidence in outcomes were reciprocally linked…Improvements occurred from baseline, but acupuncture has no specific efficacy over either placebo. The individual practitioner and the patient’s belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient’s belief (independently). Beliefs about treatment veracity shape how patients self-report outcome, complicating and confounding study interpretation.