Suppose you are thinking about trying acupuncture as a treatment for a health problem that you have. Well, how do you decide? You might go on a recommendation from a friend, or on a hunch, or maybe just desperation. But if you are a logical sort of person, you might want to look at the evidence as to whether acupuncture is effective in treating your particular problem.
If you do take this route, there are a few things you might like to bear in mind. First of all, has any research been done? If you suffer from something like low back pain or nausea, there is plenty of it, but for other conditions there is not much, or perhaps not much that gives a definitive idea of how effective acupuncture might be. Obviously, this does not mean that acupuncture is or is not effective for your problem; it just means the research has not been done. Of course in China, where acupuncture originated, they may have been treating your problem with acupuncture for millenia, but they just somehow haven’t got round to doing any double blind random controlled trials or anything like that. And the thing about good research is that it does not come cheap; which is OK if you are a multi-national drug company testing your latest product, but who is going to fund research on acupuncture? There aren’t many multi-national acupuncture companies to do that.
Furthermore, research results need to be read critically. Here are just a few of the things you need to bear in mind:
a) In any research study on acupuncture, who was it doing the acupuncture? Traditional acupuncture puts a good deal of emphasis on the skill of the acupuncturist, who knows how to find the right place to put the needle, knows how deep to insert it, knows how much or how little to manipulate the needle for a given patient; in short, needs to have had a good few years of training, and preferably a good few years of clinical experience on top of that; a study which uses people who have just had a few weeks of training (if that) might be a waste of time and money.
b) Was the treatment individualised to each patient? Some trials use the same acupuncture points for each patient, whereas the clinical reality is that a traditional acupuncturist will use different points – will give a different treatment – to different patients even when they have the same medical condition. (There is a traditional Chinese medical proverb: yì bìng tóng zhì, tóng bìng yì zhì, which means “different diseases, same treatment; same disease, different treatments”). One person’s osteoarthritic knee is not the same as another’s, and since the treatment concerned is holistic in nature, it is also relevant that the two owners of the knees are not the same either. So research which uses a standard treatment protocol for a number of patients may be missing the point (no pun intended!) A related issue is the amount and nature of the stimulation the needles are given: again, a traditional acupuncturist might choose to manipulate the needles in one of the patients so as to produce a strong dull achy feeling all around the knee, and to be content with a simple light insertion of the needles in the other patient so that the latter feels hardly anything at all.
c) Trials need to take into account the placebo effect. The placebo effect means that any medical treatment will have a positive effect on a proportion of the patients concerned. If you have a 100 people with headaches and you give them inert sugar pills which they think is medicine, some of them will get better. This means that any research needs to screen out the placebo effect. This is relatively easy if you are testing pills; you can easily give half of your patients a placebo pill and half of them the real thing, and they won’t know which they have got. However, it is not so easy with acupuncture; which is to say, it is not so easy to make someone think they have had an acupuncture treatment, when in fact they have not! There are a number of ingenious ways researchers are now trying to get round this problem, but most of these are not without their difficulties; acupuncture placebos tend to be around twice as effective as pill placebos! To complicate matters further, in a research trial for a pill, not only does the patient not know if they are getting a placebo or not, neither does the administering clinician – this is called ‘double blinding’. This cuts out the possibility that the clinician may inadvertently suggest to the patient whether they are getting a placebo or not. Clearly it is not so easy to have a double blind acupuncture trial, which is to say one in which neither the patient nor the clinician knows whether the treatment is genuine acupuncture or not. Particularly given that in traditional acupuncture the intention of the clinician is considered a crucial part of the treatment!
d) Something else to bear in mind is that a traditional acupuncturist does not look at you and just see an osteoarthritic knee, if that is what you have got; they look at you as a complete person. Their understanding of your health problem necessarily encompasses your whole self. Thus their aim is not only to provide pain relief to your knee, but to enhance your health in general. This is an important point as far as research is concerned. For instance, most people would be less than thrilled with a treatment which reduced their knee pain somewhat but in the process gave them stomach ulcers (as might happen with some painkilling medications), but a research trial might only focus on the knee and simply report the effectiveness of the treatment for knee pain. You need to know more than whether the treatment worked on the knee.
All this might suggest that most research studies on the efficacy of acupuncture may well not give you a definitive answer as to whether acupuncture will help you or not. There is only one way to get that answer of course, and that is to have the treatment.