Last week, an acupuncture story from the Center for Health Studies in Seattle came out, and the mainstream press hopped all over it. 638 randomized adults with chronic mechanical low back pain were split them into four groups: one which was given standardized acupuncture, one that was given acupuncture specifically tailored to that individual, one that was given standard medical treatments, and one that was given fake acupuncture. As in previous studies, the scientists found that acupuncture had a greater reported effect than conventional medicine, but also, that poking people with toothpicks had the same effect as traditional Chinese medicine.
Before we go on, there are a couple things we should discuss about chronic mechanical low back pain. Many of us experience back pain on a fairly regular basis. With most of us, it's fairly mild, and with some of us it's downright crippling. As I once heard paleobiologist Donald R. Prothero describe it, we are badly constructed bipeds. Humans are the only fully bipedal primate, and we're among the few fully bipedal mammals, most of the others belong to the family of macropods - the hopping family of the Kangaroo and Wallaby. The other large group of bipedal animals are birds, who, as we all are probably aware, use those other two limbs of theirs to fly (except for birds like the Ostrich, Emu, and Penguin). Of all bipeds, we have the heaviest upper body, in regards to our legs. We have great leg muscles, sure, but we're built top heavy, and all of our weight is constantly supported by an inflexible spine. Thus: humans have back problems. Thank you, Homo Erectus.
So, chronic low back pain is a fact of life. And it's not just about our construction. Some of it also comes from our mood, how we hold ourselves. If you're stressed out you're going to carry your shoulders differently, your posture will be different, you're going to tense in certain ways, you're just going to put more strain on your already hard working back.
And here's the real kicker: most conventional treatments don't have much effect on chronic back pain. It's unfortunate but it's true. Pills, stretches, anti-inflammatories, most of doesn't hit the key problems, how we hold ourselves, how we walk, the strain that we put on ourselves on a daily basis.
Now, let's go back to acupuncture - and all other practitioners of alternative medicine. There's one thing I'll say they do better at than doctors who practice scientific medicine: spending time with patients. There're a couple reasons for this. To begin with, we have more sick people than doctors. I have a friend who's currently going into her second year of residency. She's a great person, very good hearted, and she constantly has to deal with the fact that she just doesn't have the time to spend with all the patients who could use time. Practitioners of alternative medicine don't have that same problem. Most people coming to them don't have life-threatening conditions. What's more, no matter how much alternative medicine practitioners like to describe themselves as healers, we must recognize that this is their business and, like Plastic Surgeons, the high amount of time they spend with their patients is built into the bill. The don't have to hurry.
As I said, a great deal of lower back problems actually have to do with stress. A doctor's probably not going to be able to help you out here. They don't have half an hour to sit with you, talk, about your problems and help your stress levels. Alt Med practitioners, on other hand, do. This alone can have a hugely beneficial effect on a patient. That feeling that someone cares is taking the time to relax you can be great. Acupuncture includes an extended process of someone talking to you while you lie down. And when it comes to something like lower back pain, yes, that can be beneficial.
Another big part of why alternative medicine works is because people using it believe it's going to. Pain is a subjective experience. Sensation is received via nerve endings, interpreted by the brain and delivered to our consciousness. Because there's an interpretive element to pain sensation, it is particularly vulnerable to the placebo effect. And acupuncture will definitely stimulate that. Your brain thinks that something is happening, you think that there's something that will work, and therefore... it does. And if there's anything that recent study suggested, it's that acupuncture is based on the placebo effect.
Acupuncture is built on the theory that there is a metaphysical life-energy inside you called Qi or Chi. This Qi flows throughout your body by way of "acupoints," and when it is blocked it causes sickness. Traditional acupuncture states that the placement of thin needles into these acupoints will restore the flow of Qi, helping to heal the body to full working condition. In the Seattle study, toothpicks were poked on these acupoints, but not into them, down to the level where traditional acupuncture demands. There are certain offshoots of acupuncture which will claim that you just have to be near the acupoints to have an effect, but that's really not the traditional belief system of acupuncture. What's more, there have been other studies which have shown similarities between real and sham acupuncture where the needles have not been placed anywhere near traditional acupoints. What this really amounts to is what we skeptics refer to as "special pleading," Acupuncturists proposing that what the study showed was that the placebo was not a placebo. The truth for practitioners of acupuncture is that, when we look at the combined weight of all studies on acupuncture, the evidence suggests that the fundamentals of acupuncture - Qi, acupoints, blockages - simply have no basis in human physiology.
But the papers that picked up the story about this study didn't highlight that the procedure was shown to have no greater effect than placebo. Instead, you had from Business Week, "Acupuncture: Real Or Fake, Eases Back Pain," from Reuters, "Acupuncture, real or fake, helps aching back: study," or the Washington Post's "Does Acupuncture Help Your Back?" They're articles that really want to talk about how the acupuncture worked, and not that the fundamentals of the practice are flawed. The story that was picked up in the media was that Acupuncture was a safe way to cure lower back pain, when really what the article tells us is that at its core, there probably isn't anything to it other than what the brains of the patients are producing.
There's something that I want to make clear here. I am not saying that it's impossible that acupuncture works. Personally, I don't believe that the scientific evidence has so far pointed to any efficacy for it, but there are people out there that swear by it and I don't really have a problem with it. There are a couple dangers associated with it that I don't feel people are quite aware enough of. Since certain acupuncturists don't hold with the germ theory of diseases, there have been a couple cases where unsterilized needles have spread deadly viruses like Hepatitis. Also, there have been cases where acupuncturists punctured the chest wall of patients, causing collapsed lungs. And of course, there's always the danger that a person with some deadly illness will delay conventional medicine, giving their disease the chance it needs to get worse. But that's not the point of this article, and I think with a bit of regulation, sterilization, at the very least, would cease to be a problem. What I'm saying is that this particular study which is being looked at by the press does not say that acupuncture works. I'm saying that the evidence from this study suggests a placebo effect and not one from the needles themselves.
Why do journalists keep missing the real story? Is it just because they think this is what we want to see or is it that they just don't have enough science training to understand? Who knows? Maybe the problem's us as readers. James Randi still talks about when he demonstrated that "psychic surgery" was a sham on "The Tonight Show". The audience response? "Can you get me in touch with that psychic surgeon?" Maybe I'm old fashioned, but I thought it was the journalist's responsibility to get the story right and make sure we understand it. Perhaps it comes down to this strange belief in balancing stories, this theory that you need to present both sides of a story equally, even when the stories aren't equal. But while that may make sense in the context of humanities, science is about fact. A flat Earth is not an equal proposition to a round one, and when a study shows that a placebo works as well as a medicine, it means that the medicine itself is probably a placebo.
The real problem may be, the story that acupuncture doesn't work any better than a placebo isn't sexy. If you look at the recent study honestly, no amount of special pleading can counter the fact that the theoretical underpinnings of acupuncture were dealt a blow. I like the idea that instead of getting needles stuck into me, I can have someone chat me up and occasionally poke me with toothpicks and that'll have the same effect. Certainly it'd be cleaner and safer, and probably cheaper too. But that's not as good a story, so instead we see a story about how traditional Chinese medicine wins against the evil forces of science.
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